HomeMy WebLinkAboutMINUTES - 12161997 - D11 D.11
THE BOARD OF SUPERVISORS OF
CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on December 16, 1997, by the following vote:
AYES: Supervisors Rogers, Uilkema, Gerber, Canciamilla and DeSaulnier
NOES: None
ABSENT: None
ABSTAIN: None
SUBJECT: Departmental Performance Report
William B. Walker, M.D., Director, Health Services Department, provided the Board
with a departmental performance report for the 1996/1997 Fiscal Year.
Subsequent to the presentation by Dr. Walker, the Board took the following action:
1. ACCEPTED departmental performance report from William B. Walker, M.D.,
Director, Health Services Department.
I hereby certify that the foregoing is a true and
correct copy of an action taken and entered on
the minutes of the Board of Supervisors on the
date shown.
ATTESTED: December 16, 1997
Phil Batchelor, Clerk of the Board of
Supervisors and County Administrator
lCampler, Deputy Clerk
cc: County Administrator
Health Services Department
� D !I
� Contra Costa
� HealtServices Department-
Annuaf
Performance'
i
� Review 1997
i
i
i
Senior Staff
William B. Walker,MD
Director
Wendel Brunner,MD '
Director
Contra Costa Public Health
Milt Camhi ,
Executive Director
Contra Costa Health Plan
Chuck Deutschman
Director
Contra Costa Community
Substance Abuse Services
Mary Foran
Assistant to the Director
Pat Godley '
Chief Financial Officer
Julie Kelley '
Assistant for Program&Policy
Frank Puglisi ,
Executive Director
Contra Costa Regional Medical Center
& Contra Costa Health Centers
Steve Tremain,MD
Director
Medical Staff Affairs
Donna ligand
Director
Contra Costa Mental Health
Roger Wong ,
Director
Personnel
Table of Contents
MissionStatement ................................................................................................................. i
OrganizationChart................................................................................................................ ii
...
Organization Chart Description ............................................................................................ iii
SECTION I
Organization Structure .................................................................................. 9
SECTION II
Resources
FinancialResources................................................................................................................ 11
Personnel Resources 11
AffirmativeAction ................................................................................................................. 11
SickLeave....... ................................................................................................................. 11
Staff Developmentent12
Automation ........................................................................................................................... 12
SECTION III
Service Delivery System
Hospitalsand Health Centers ................................................................................................ 15
MentalHealth ....................................................................................................................... 15
PublicHealth......................................................................................................................... 16
Community Substance Abuse Services 17
ContraCosta Health Plan...................................................................................................... 19
Environmental Health Program.............................................................................................. 19
Hazardous Materials Programs. 20
Emergency Medical Services .................................................................................................. 21
Customer Profile
Hospitaland Health Centers.................................................................................................. 23
Mental Health 23
PublicHealth......................................................................................................................... 23
Community Substance Abuse Services ..........................
ContraCosta Health Plan...................................................................................................... 24
Environmental Health .............................................
Hazardous Materials Program....................................................................................... ........ 24
Emergency Medical Services . ....... . 24
Customer Relationships
Hospital and Health Centers ................................................................................................. 25
MentalHealth ............................................................................................... 25
PublicHealth......................................................................................................................... 26
Table of Contents
Continued
Community Substance Abuse Services .................................... `.
ContraCosta Health Plan...................................................................................................... 27
Emergency Medical Services .................................................................................................. 27
SECTION IV
Annual Performance
Performance Indicators
Hospitaland Health Centers................................................................................................. 29
MentalHealth ....................................................................................................................... 29
PublicHealth ........................................................................................................................ 30
Community Substance Abuse Services................................................................................ 30
Contra Costa Health Plan ..................................................................................................... 30
EnvironmentalHealth........................................................................................................... 30
HazardousMaterials ............................................................................................................. 30
Emergency Medical Services ............................................................................................... 31
Accomplishments
Hospital and Health Centers ................................................................................................. 33 '
MentalHealth ....................................................................................................................... 33
PublicHealth ........................................................................................................................ 34
Community Substance Abuse Services................................................................................ 37
ContraCosta Health Plan ..................................................................................................... 38
Environmental Health 38
HazardousMaterials ............................................................................................................. 38 �.
Emergency Medical Services .................................................................................:............. 39
SECTION V
Challenges & New Directions
Challenges ............................................................................................................................ 41
NewDirections ..................................................................................................................... 42
APPENDIX
Begins After Page 42
Attachment A.................................................................. HSD County Subsidy Graph
Attachment B.................................................................. HSD Budget/FY 1997-98
Attachment C.................................................................. Performance Indicators
Table 1 ............................................................................ Staffing Patterns
Table 2 ............................................................................ Affirmative Action Pattern -- 1997
Table 3 ............................................................................ Sick Leave Usage FY 1996-97
1
Con ra Costa
1
Hea(t6 SeyViCeS Mission Statement
The Health Services Department
cares for and improves the health
of all people in Contra Costa
' County with special attention to
those who are most vulnerable to
health problems and their con se-
quences.
Values
• We are an integrated system of
health care services, com-
munity health improve-
ment and environmental
protection.
• We emphasize quality of ser-
f q tY
vices and respect for all
who use and work in our
programs.
• We anticipate community
health needs and change
' to meet those needs.
• We work in partnership with
1 our patients, cities and
diverse communities, as
well as other health, educa-
tion and human service
agencies.
1 We encourage creative, ethical
and tenacious leadership
to implement effective
health policies and pro-
grams.
i _
ORGANIZATIONAL CHART
DESCRIPTION
HEALTH SERVICES ADMINISTRATION
Health Services Director Assistant to the Director
William Walker, MD Mary Foran
Secretary to the Director Chief Finance Officer
Darlene Allen Pat Godley
Medical Staff Affairs Director Assistant for Policy and Planning
' Steve Tremain, MD Julie Kelley
Emergency Medical Services Director Executive Assistant
' Art Lathrop to the Hazardous Materials Commission
Elinor Blake
Diversity Services Coordinator
Carl Coates Ombudsman Program
Evelyn Rinzler
DIVISION LEADERSHIP
Hospital and Health Centers Contra Costa Health Plan
Executive Director Executive Director
' Frank Puglisi Milt Camhi
Mental Health Director Substance Abuse Director
1 Donna Wigand Chuck Deutschman
Public Health Director Environmental Health Director
' Wendel Brunner, MD Ken Stuart
Personnel Director Hazardous Materials Program Director
Roger Wong Lew Pascalli
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anizational StructIffe
The Health Services Department is made up of the following divisions:
• Contra Costa Regional Medical Center& Contra Costa Health Centers
• Contra Costa Mental Health
• Contra Costa Public Health
• Contra Costa Community Substance Abuse Services
' • Contra Costa Health Plan
• Contra Costa Environmental Health
• Contra Costa Hazardous Materials Programs
• Contra Costa Emergency Medical Services
' Finance
• Personnel
• Office of the Director
The Office of the Director, Finance and Per- general accounting, program reimbursement,
' sonnel provide centralized administration and and special projects and evaluation.
policy direction for the operating divisions of
the Department. Personnel provides assis- The Office of the Director also includes De-
' tance with recruitment, selection, classifica- partment-wide broad policy initiatives such as
tion, compensation, benefits, employee health the Hazardous Materials Commission,Partners
and employee relations. It also assures adher- for Health, Center for Health, Diversity Ser-
' ence to the provisions of the county's own vices, Office for Service Integration and the
regulations including memoranda of under- Women's Advisory Committee.
standing with the employee organizations.
' We engage in numerous partnerships, through
Finance manages all fiscal functions including contracts,coalitions, and joint efforts. Specific
billing,contracts and grants,utilization review, partnerships are described in the detailed sec-
payroll, data processing, budget, patient and tions which follow.
i9
1
' Financial Resources sion of services in Antioch and Bay Point and
Contra Costa Health Services receives fiscal enhancement of the Appointment Unit Sys-
support through various funding mechanisms. tem. The Mental Health and Public Health Di-
The recommended budget for 1997-98 is visions also experienced an increase in staff-
$381.3 million dollars, $35.6 million of which ing(11.8/o and 3.7/0, respectively) due to ex-
is net county cost(Attachment A). pansion of programs and changes from tempo-
rary or contract staff to permanent staff per
' Sources of funding include Medicare,Medi- agreement with Local One.Cal, Private Pay/Insurance, Bond Revenues,
Tobacco Tax, SB855, VLF revenue, interest
rmative Action
income, Realignment monies (Hospital and The composition of the Health Services De-
Health Centers, CCHP); State CCS program partment staff reflects the workforce in the
(Public Health); federal and state grants,cli- community.The only minor exceptions are in
ent fees (Public Health and Substance Abuse); the areas of Hispanic employment, which re-
Drug Medi-Cal, federal block grant, and state quire 0.5% increase in order to attain
allocation(Substance Abuse); conservatorship workforce parity. Table 2 lists the Health Ser-
fees (Conservator);property taxes (Emer- vice workforce ethnicity,parity and depart-
gency Medical Services); Inspection Fees, ment goals. Although an ethnic distribution by
Public Health Permits, Hazardous Waste Gen- job category (i.e.professional, officials-ad-
erator Fees (Environmental Health/Hazardous ministrators,technicians) is available, it is not
Materials Program); Ryan White funding reported due to the current inability to com-
(AIDS); State-Federal Medi-Cal Administra- pare workforce distribution by job category.
tive Activities/Targeted Case Management
(Public Health/Public Guardian), SAMSHA This year,the Department hired a full time Di-
grant funds, SSVSSP (Mental Health); County versity Services Coordinator to carry out em-
General Funds (multiple programs.)These are ployee Affirmative Action recruitment and
summarized in Attachment B. monitoring and focus attention on creating a
culturally competent workforce, one that is
Personnel Resources well-prepared to serve our diverse patient and
The overall level of staffing for Health Ser- user population. We will be increasing atten-
' vices experienced a 2.6% increase in 1997. tion to diversity/cultural competency training
Additions to staff this year(Table 1)included for all staff.
the Contra Costa Health Plan,which grew by
' three employees due to continued expansion Sick Leave
of the Plan. Ambulatory Care Staff were in- Table 3 displays the amount of sick leave used
creased by 23.4 FTEs (9.2%)due to expan- by each Division of the Department during fis-
t11
cal year 1996/97 as compared to the amount The Department will be examining how the CQI ,
accrued. It is possible to use more sick leave in principles and practices might be applied in other
a year than accrued because of the year to year Divisions.
carry-over of sick leave.The average amount of
sick leave use per FTE is 63.4 hours. The range
Automationby Division varies from a low of 41.3 hours to a
high of 78.8 hours in the 12 month period.How- Information Systems technology plays a major
ever;the current reporting system does not al- role in supporting medical and administrative
low us to distinguish between regular sick leave staff activities. With 23 multi-user computer '
and sick leave which is used up upon retirement. systems as well as hundreds of individual per-
In addition, these figures can not reveal situa- sonal computers throughout the Department,
tions where high sick leave use is related to cata- each Division has access to modern technology.
strophic illness as opposed to frequent short ill-
nesses. Therefore, we have no explanation for The Department Information Systems accom-
the variations by Division. Next year, we will plishments this year includes: '
carry out further analysis of the variations in
sick leave usage in order to develop a better un- New PCP Assignment System -Due to re-
derstanding of the current patterns. quirements for the,Local Initiative (L.I.), a '
new Primary Care Physician(PCP) and Pri-
Staff Development mary Care Site (PCS) system was created and
,
Performance evaluations are distributed to su- implemented. Member information is col-
lected from the State's HCO program, Kaiser,
pervisors on a regular basis and required to be the CCF1P system,the Global Appointment
submitted in a timely fashion. A new monitor-
ing system has been implemented which has re- tem;patient choices and default assignments -,
suited in a substantial decrease in delinquent are then processed and updated to multiple
evaluations submitted.
user systems.
All staff are encouraged during the annual evalu- CCHP:Membership System-A new CCHP
ation process to identify training needs and to membership database was created. This data-
develop a plan to meet them.A system to regis- base is updated daily, from the CCHP system,
ter staff for the offerings of the County Training
with each member's demographic, eligibility,
Institute is in place. PCP and PCS information. The system is ac-
cessible by Windows-based PCS (Primary '
The hospital has developed a number of ad hoc Care Site) as well as touch tone telephones.
committees which serve to enhance professional
standards. In particular, there is a Continuous Local Initiative Encounter Reporting- Our
Quality Improvement(CQI)Committee. There CCHP Utilization database structure was en- ,
is also a Joint Labor/Management Committee hanced to accept claims data from multiple
which serves to meet the objectives of both the sources and new programs were created to '
Department and staff in a cooperative manner. produce;monthly encounter files to meet the
With the imminent opening of the new hospital State's:L.I. reporting requirements. New in-
facility,there will be an even greater reliance on terfaces for standard claims, Pharmacy claims
ad hoc task forces to ensure that all concerns
are addressed.
12 ,
and Physicians claims were created which, in Medicare Electronic Billing-Automated
addition to complying with mandated require- electronic billing programs were created to
ments, will dramatically enhance our ability capture claims information from the Keane
' to create internal PCP-level utilization re- Hospital and Clinic billing systems, for sub-
ports. mission to Blue Shield.
CCHP Claims Processing Enhancements- Data Warehouse -The data warehouse
Major enhancements were created to auto- project, a centralized relational database and
mate the calculation of"Medi-Cal rates"for decision support system,was initiated. The
reimbursing our Community Network Provid- warehouse currently contains CCHP utiliza-
ers, and to allow capture of detail claims in- tion,membership and provider information.
formation required for L.I. encounter report- Both standard and ad-hoc real time reporting,
' ing. using Windows-based report writing tools, is
now available for Information Systems, Fi-
Physician Utilization Reporting System- nance and CCHP staff.
Each quarter, utilization data is captured and
formatted into both Provider and Divisional New Hospital Network Implementation -A
' level reports. These reports are presented in state-of-the-art fiber optics based communica-
both graphical and numerical structured pro- tions infrastructure was designed and installed
files that group Providers by service level in the new hospital. The new local area net-
specialty. work(LAN) is in the process of being con-
nected to the Health Services, wide area net-
Substance Abuse Division's MIS Selection work(WAN).
' -After a lengthy and exhaustive RFP and
evaluation process, a MIS vendor was chosen, PCN Eligibility Update-A daily electronic
and a project plan established, that will pro- file update process was created for CCHP .
vide automated systems to each of our County members eligible for prescriptions through the
and Contractor service and administration lo- Pharmaceutical Care Network. This new pro-
cations. cess replaced the weekly batch process.
Home Health System -A major hardware Electronic Signatures for Homeless System
' and software upgrade was implemented for -All medical record entries are now electroni-
our Home Health Agency. cally signed by our Public Health Nurses us-
ing password-enabled signature software.
' Targeted Case Management (TCM) -A
system was created to capture and report Help Desk on Internet-The Health Services
TCM activity to the State . designed and operated Help Desk information
' and referral system is now accessible through
Health Services E-Mail Network-A WAN- the Internet.
' Based E-mail network was put in place that
provides E-mail services to employees using
PCS and networked terminals. Using the
' SMTP protocol, multiple in-house E-mail
systems are set up to communicate through
our mail server.
' 13
1
'
Section III
' i
'
1 .
vice
1
•'• Service Defive'Q9 SNstem
The Health Services Department is responsible for providing a continuum of health
' services to county residents, ranging from direct and prevention services for indi-
viduals to environmental and public health services that protect the well being of the
entire community. HSD works cooperatively with federal, state, regional and local
programs and the private sector to assure comprehensive systems of health care and
health protection.
' HOSpital centers are located in Richmond(primary, spe-
'
& Health Centers cialty, and ancilliary),Martinez(primary, spe-
cialty and ancillary),Bay Point(primary care),
Early in 1998, we will move from Merrithew Pittsburg(primary, specialty,and ancillary),
Memorial Hospital to our new state-of-the-art Brentwood(primary care), and Concord(pri-
1 Contra Costa Regional Medical Center. mary care). Specialized geriatric outpatient
services are provided at the Older Adult
Our hospital is a general acute care teaching Health Centers, located in Antioch(co-located
' hospital providing a full range of diagnostic with primary care health center),Concord(co-
and therapeutic services including emergency, located with primary care health center) and El
1 medical, surgical,perinatal,pediatric and psy- Cerrito. The specialty care (provided at noted
chiatric services. Ancillary services include clinics) includes dental, rehabilitation,podia-
Diagnostic Imaging, Clinical Laboratory, try, infectious disease,pediatrics, eye, derma-
Pharmacy, Rehabilitation and Cardiopulmo- tology,orthopedics,urology,ENT, GYN and
nary Care. We are-licensed to provide basic Hansen's Disease. A new site,the Center for
Emergency Care Services. In addition, a 24- Health,will be open in North Richmond late
hour Psychiatric Emergency Services Unit 1998. It will combine primary care with spe-
provides psychiatric evaluation and treatment. cial health improvement programs for the sur-
The division is also responsible for the provi- rounding neighborhoods.
1 sion of health care to the adult and juvenile
detention population. Mental Health
1 A network of nine ambulatory care centers Adult Services. Mental health services for
provide outpatient, specialty, and geriatric adults are provided through a single point of
care' services. The primary and specialty care coordination and integration. The delivery sys-
tem deemphasizes institutional care and pro-
15
motes community support services. In addi- The Children's Mental Health System of
tion to regular mental health services such as Care is linked with multiple entities includ-
assessment and therapeutic intervention,the ing the school system,probation, social ser-
following services are provided either by vices, and the health care provider system. '
County or contracted service providers: Day
Treatment, Crisis Residential and Adult Resi- As a result of these linkages, county-operated
dential,-Vocational,Crisis Intervention and programs were reorganized into teams to ,
Stabilization, and Case Management/Broker- identify specialized"matrix" staff with ex-
age. pertise and responsibility for working with
multiple programs. These teams provide '
An Intensive Case Management pilot, imple- "high end" services (typically more intensive
mented in East County last year,has success- and expensive)to consumers. This strategy '
fully demonstrated a new service model which of service delivery will assist in identifying
has served as a catalyst for structural change gaps and strengthening services in the Sys-
in the delivery of adult care throughout the tem of Care continuum in order to maintain
county. The service delivery system in Central children in their homes.
and West County regional adult clinics will
change to Intensive Case Management mod- Mental Health Crisis Services. Mental
els, operating on a seven day a week, 24 hour Health Crisis Services are available to all
a day coverage basis, within the next few county residents, regardless of age or payor
months. This model highlights the provision source. This service exists as an outpatient, '
of necessary services for successful commu- psychiatric emergency and crisis service at
pity tenure,thus avoiding costly hospitaliza- our hospital 24 hours a day, and from 8:00
tions. am to 5:00 pm, Monday through Friday at ,
the West County site. These programs pro-
Children's Services. Children's mental health vide irmnediate access as a mental health
services are provided through a newly estab- drop-in service as well as a"5150" evalua-
lished System of Care (SOC) or continuum of tion and treatment center.
services to meet the varied mental health
needs of children, adolescents, and their fami- Crisis Services provides Hospital Liaison
lies. The SOC (staffed by county employees staff for the monitoring of all adult psychiat-
and programs provided through contracts with ric inpatient admissions to our hospital and ,
community-based organizations)provides one contract hospitals as a result of Phase I Inpa-
seamless, coordinated, and collaborative sys- tient Medi-Cal Consolidation. These staff fa-
tem for delivery of mental health services cilitate system-wide treatment plans and ad-
county-wide. The current SOC for Children's vocate for case management for high users of
Mental Health Services consists of five crisis and acute care facilities. As a result of
county-operated programs and 16 contract Phase II Outpatient Medi-Cal Consolidation,
programs. Six of the contracts are for residen- Crisis will be responsible for all access to
tial or hospital-based services and ten are for and authorization for services in the Adult
less intensive community-based services. Of System of Care and on an as-needed basis for
the five county-operated programs,three are services in the Children's System of Care.
regional outpatient clinics in Central,East,
and West County and two (YIACT and AB Public Health
3632) are interagency programs which are
based in Central County but serve the whole The Public Health Division provides a range
of clinical services and community outreach,
count},
16
nutrition services and services for develop- Community-based prevention services are
mentally delayed children and adults,commu- implemented throughout the county in part-
nity-wide prevention programs and health nership with community-based organizations.
data collection and assessment. Those services include AIDS prevention and
Clinical services include Well Child and Pri- education,tobacco control and cessation,
mary Care Pediatrics, Family Planning, Sexu- community and domestic violence prevention,
' ally Transmitted Diseases, Tuberculosis Clin- chronic disease control including nutrition
ics, Immunization, and HIV Testing and education and active living projects, lead poi-
Counseling. In addition,there are mobile sonmg prevention, and childhood injury pre-
community clinical services for homeless vention programs. Communicable Disease
people (Health Care for the Homeless) and for Control focuses on preventing the spread of
those who do not present for care (Health on communicable diseases in the community, es-
Wheels Mobile Clinic Van). The Home pecially tuberculosis and sexually transmitted
Health Agency provided over 31,929 home diseases.
visits and Public Health Nurses provided addi-
A
tional home visits and case management for fundamental role of Public Health is to col-
children and families. Public Health provides lect data and assess the health conditions and
' services in schools through the Dental Disease needs of the community, and evaluate the ef-
Prevention Program and School-Based Public fectiveness of public health and community
Health Clinics in Richmond and Bay Point. activities to improve the health of county resi-
t Cdents. The Public Health Data and Evaluation
Clinic services are supported by the Public
Health Laboratory,which also provides refer- staff work with Communicable Disease Con-
Health
laboratory services for tuberculosis, para- trol, Clinic Services, Family, Maternal, and
' sites, and other communicable diseases to Child Health, and the Community Wellness
non-Health Department providers throughout and Prevention Program to develop commu-
' the county. Clinic services are also comple- nity health indicators and evaluate program
mented by Community Outreach Workers effectiveness.
working in neighborhoods and with commu-
nity groups to identify pregnant women, chil- Many of the our programs are State or Feder-
dren in need of health care,AIDS prevention, ally mandated with categorical funding at-
TB and STD follow-up and treatment, and tached to them, which defines populations to
1 homeless outreach. be served and limits services to be provided.
Non-clinical direct services include Women, Community Substance
' Infants, and Children's(WIC) services which Abuse Services
provide monthly food vouchers to over 7,000
low-income women and children, and Senior The Community Substance Abuse Services
' Nutrition Services which serves hot lunches to Division(CSAS) operates and contracts for
seniors at 19 sites throughout the county and services through a community-based con-
provide Home Delivered Meals to homebound tinuum of care that stresses accountability
' seniors and people with AIDS. The George and outcomes in a culturally competent, client
Miller Centers in Richmond and Concord pro- -driven manner. CSAS focuses on three pri-
vide therapeutic services and education for de- mary areas: Prevention, Treatment, and Spe-
velopmentally disabled adults and children. cialized Services.
1 17
Prevention. CSAS provides technical assis- Wollam House in Bay Point and two of the
tance,training, and resources to regional sub- Ujima Family Recovery programs serve preg-
stance abuse prevention coalitions and nant and parenting women, including their
grassroots organizations and provides staff children. Sunrise House in Concord is for both '
support to the Community Partnership Forum, men and women and Thunder Road in Oak-
an alliance of local prevention groups that to- land serves youth. ,
gether with the Substance Abuse Advisory
Board(SAAB) implement the county's Sub- Residential programs are 24 hours a day, 7
stance Abuse Action Plan. days a week social model environments that
require a minimum of 40 hours per week of
Other programs with a prevention focus in- counseling and/or structured therapeutic ac-
clude Alcohol, Drug Abuse, and Perinatal tivities. Treatment includes assessment, de- ,
Task Force (ADAPT)an interagency taskforce velopment and monitoring of individualized
developed to reduce and reverse the negative treatment and discharge plans,AIDS and STD
consequences of substance use during preg- education, vocational counseling and employ-
nancy through service coordination and pro- ment referrals. To insure continued care,
fessional training. In addition, CSAS works CSAS requires formal service linkage among
with the Council for Perinatal Health to facili- various treatment modalities.
tate system-wide program planning,policy de-
velopment, and interventions to improve peri- Specialized Services. CSAS operates and con-
natal outcomes. tracts to provide a number of specialized ser- '
vices to address client needs. For example,we
CSAS providers allocate at least 20% of their work with the court,parole and probation
Federal Block Grant resources to primary pre- mandated substance abuse treatment and inter-
vention activities. CSAS contracts with com- vention services which include the county-
munity-based agencies to provide information wide Driving Under the Influence program;
and referral services, education and refusal Drug Diversion, state and federal parolee/pro-
skills training, youth alternative activities, bationer programs; and Supervised Treatment
school based education, early intervention, And Recovery Services (STAR) in Richmond.
and support groups.
Other specialized CSAS services include the
Treatment. CSAS operates three county-run Methadone program (Bay Area Addiction Re-
drug-free outpatient substance abuse treatment search and Treatment, Inc.(BAART))to pro-
programs and contracts with several outpatient vide methadone maintenance and detox for
services throughout the county. Recovery sites heroin.addicts; services to pregnant and ,
in East and West County also provide services parenting women such as Born Free, which
to pregnant and parenting women. provides outreach, intervention, and case man-
agement; and the Council for Perinatal Health
Residential services are provided by one (CPH) a joint effort with Public Health's Fam-
county-operated residential treatment facility, ily,Maternal, and Child Health program to fa- .
Discovery House, in Pacheco and contracts for cilitate system-wide program planning,policy
residential treatment and transitional housing development, and interventions to improve
services with Neighborhood House's Fauerso perinatal outcomes; and Vocational Services.
Recovery Center in Richmond, and Bi-Belt's
Diablo Valley Ranch in Clayton. These pro-
grams only accept male clients. Bi-Belt's '
18
i
' CSAS services are defined to a great extent by Retail Food Protection Program is charged
the funding sources, State or Federal,which with assuring that purchased food is whole-
support them. some, and that it has been produced under
conditions and practices that are safe and sani-
Contra Costa Health Plan tar'' The program inspects over 4,000 restau-
rants,markets, bakeries, schools, vehicles, and
' Contra Costa Health Plan (CCHP)is a county- caterers in the County. The program also does
operated, state-licensed, federally-qualified routine and complaint sanitation inspections
Health Maintenance Organization(HMO). It for detention facilities,juvenile facilities, and
utilizes Health Services Department programs massage parlors.
for most of the health care provided to its
members. These programs include services of Consumer Protection Program ensures that
' the Hospital and Health Centers, Public Health the County's food and water are safe and sani-
(immunizations, CHDP services),Mental tary;public recreational and public swimming
Health and Substance Abuse services. pools and spas are free of safety hazards and
disease; and that new and remodeled food and
CCHP uses community hospitals and provid- pool facilities are constructed to assure com-
ers for services not offered through our own pliance with appropriate laws and regulations.
Health Services Department, (e.g., open heart With over 1,500 public pools and spas, 160
surgery) and as back up for selected county small water systems, 260 construction plans
' services (e.g., optometry, dental). In addition, submitted annually, 300 annual temporary
in emergencies, members may use community food events, and 240 mobile food preparation
hospital emergency facilities. The Contra units, the staff provide routine and complaint
' Costa Health Plan Local Initiative for Medi- inspections, plan check for proper design,
Cal program contracts with Health Services, as ventilation,plumbing, and auxiliary structures,
well as traditional Medi-Cal community pro- education, and event oversight to ensure com-
viders and Planned Parenthood for primary pliance. The responsibility for recreational
care and with community specialists and hos- health(such as pools and spas), retail food as
pitals. Kaiser Health Plan is also a subcontrac- well as the mobile and temporary food units
for for Medi-Cal. are mandated to the county environmental
health unit by state law. Either the county or
1 As a state-licensed, federally qualified HMO, the state Office of Drinking Water must pro-
CCHP is subject to both federal and state re- vide the small water system program. The
quirements for the level of benefits given to county has been certified as the Local En-
members. The state and federal governments forcement Agency. Drinking water laws are
impose additional benefit requirements for established at the state level and must be
AFDC, other Medi-Cal and Medicare mem- equivalent to or more stringent than federal
' bers. water laws.
Environmental Land Use and Development Program safe-
Health Program guards and promotes the health and well being
Environmental Health provides administrative of the public through the application of envi-
support and oversight to programs which ad- ronmental health principles to effective land
dress the environmental components of health use. Staff of the program review some 500
throughout the county. land use proposals annually; issue over 200
on-site wastewater disposal system permits
19
. I i
annually and inspect their construction or also a local option program, and the Contra ,
abandonment; respond to complaints about Costa County LEA has been designated and
broken sewer laterals or mains and failing sep- certified by the State Department of Health
tic systems; and monitor the activities of sep- Services to enforce all state and local laws and
tic tank and other vehicles for liquid disposal. regulations pertaining to owners and operators
The private well construction or abandonment of medical waste generating facilities. The
program staff permit and inspect over 1500 staff is responsible for permitting and inspect- '
individual water wells, soil borings and ing sixty-seven permitted facilities and over-
groundwater,monitoring wells annually to en- seeing the activities of 500 small generators of
sure they are properly constructed, main- medical waste annually. '
tained, and destroyed. State law mandates re-
sponsibility for these programs, and local ordi- Hazardous Materials
nances used in the program must meet state Programs i
minimum standards.
As the State Certified Uniform Program ,
Solid and Medical Waste Management Pro- Agency(CUPA)for all of Contra Costa
gram protects the health, safety and well-be- County, staff of the Hazardous Materials Pro-
ing of the public and preserves and improves grams provide oversight, guidance, investiga- '
the quality of the environment by assuring tion and enforcement of the laws involving
proper storage and disposal of solid waste. A the handling, storage and processing of haz-
local option program,the Contra Costa ardous materials in order to assure that the ,
County Local Enforcement Agency(LEA)has health and safety of the community is not
been designated and certified by the California jeopardized.
Integrated Waste Management Board to en-
force all state and local laws and regulations Hazardous Waste Generator Program moni-
pertaining to owners and operators of solid tors facilities to ensure safe and legal han-
waste facilities in Contra Costa.County and dling, storage, and disposal of hazardous
the seventeen incorporated cities, except the wastes. Businesses in Contra Costa County
City of Pittsburg. Program activities include that generate hazardous wastes are regulated
approving solid waste facilities' permits, by this program. HSD conducts compliance
monthly inspections of four landfills,two inspections of these businesses every two
transfer stations, and one compost facility; years. ,
monthly, quarterly, and annual inspections of
fourteen closed, illegal and abandoned sites, Underground Storage Tank Program regu-
three sludge spreading operations, and two lates underground tanks which store hazard-
soil remediation facilities. The Code Enforce- ous materials which have the potential of
ment staff investigates over 1,600 household leaking. These tanks must be registered,per-
trash and garbage complaints annually and mitted,tested, and inspected. The Health Ser- ,
provides follow-up corrections. vices Department(HSD)issues permits and
regulates these facilities to ensure that tanks
The medical waste program protects the health are monitored for leaks to prevent soil and ,
of the public,health care facility personnel, ground water contamination. In addition,
and landfill personnel from exposure to medi- HSD reviews plans,performs on-site inspec-
cal wastes containing potentially communi- tions and issues permits for all new tank in- ,
cable pathogenic organisms. This program is stallations and tank removals.
20 ,
Hazardous Materials Release Response and locations of chemical spills, illegal drug labs,
Inventory Program and Uniform Fire Code pipeline leaks and illegal dumping of hazard-
Article 80.103(b) and(c) cover over 1,200 ous wastes or chemicals. They provide identi-
businesses in Contra Costa County, including fication of unknown substances, health haz-
major oil refineries and chemical plants. This ardous wastes or chemicals. In addition,they
program, also referred to as the Business Plan initiate the community warning system Bevel-
' Program,requires businesses to submit a plan oped to warn the public in case of toxic spills,
and an inventory of hazardous materials stored fires and other disasters.
on their site with a map of their facility, show-
ing the storage location of hazardous materials Emergency Medical
and emergency equipment. Facilities are in-
spected by Hazardous Materials personnel to Services (EMS)
' ensure compliance with regulations. EMS provides overall direction,planning, and
monitoring for the County's prehospital
' Household Hazardous Waste Program pro- Emergency Medical Service system. The EMS
vides ongoing weekend collection events for system consists of fire, ambulance, and related
both recyclable and toxic household waste. services which respond to 9-1-1 medical
These events are provided free to the public. emergencies. A variety of agencies and
In addition,the program provides information organizations work together to provide per-
about safe alternatives to many products sons who experience medical emergencies
' which contain hazardous materials that may with a timely response delivered in a profes-
leach from the landfill into the water supply. sional and medically appropriate manner.
EMS providers include fire services, ground
'. Risk Management and Prevention Program and air ambulance services,public safety
seeks to prevent the accidental release of dispatch centers, law enforcement agencies,
' "Acutely Hazardous Materials" (AHM) and to and hospitals with their medical staffs. Sup-
prepare for public protection in the event of a porting the direct service components are
release. Facilities are required to prepare de- educational and training institutions, citizen
tailed, step-by-step hazard analyses to identify and medical advisory groups, and various
ways to prevent accidental releases of ARMs other public and voluntary organizations.
and to develop Off-site Consequence Analyses
for emergency response planning. EMS develops and administers service con-
tracts with emergency ambulance providers to
Spill Prevention, Control and Countermea- assure county-wide emergency ambulance
sure Program (SPCC) seeks to assure that the coverage provided in accordance with high
218 sites in Contra Costa that have above standards of performance and patient care.
ground storage tanks which store or transport The EMS Agency provides oversight of the
' bulk hazardous materials have filed an SPCC County paramedic program including devel-
plan with the State Water Resource Control opment of treatment protocols for paramedics
' Board. to follow while caring for patients in the field,
designation of base hospitals to provide on-
Incident Response Program provides Emer- line medical direction to paramedics, accredi-
gency response staff on-call 24 hours a day to tation for paramedics working in the county,
provide technical assistance and oversight at and coordination of quality assurance activi-
21
ties, Planning and monitoring services are
provided by the EMS Agency for the special-
ized trauma care system developed to assure
that victims of automobile accidents and 1
other major trauma receive the highest level
of care.
1
i
i
1
1
i
1
22 ,
1 ❖ Customer Pro i fe
' HSD clients are defined in multiple ways. For some, we are the provider of last
resort,for others the provider of choice, and still others, the only provider for
' certain unique services.
Hospital &. Health legislation which govern the use of or access
Centers to funds. To be eligible for most mental health
1 services, a child or adolescent must have a
We offer services to all residents of Contra mental health diagnosis from the Diagnostic
' Costa County. The majority of our patients in- and Statistical Manual of Mental Disorders
clude those who are on Medi-Cal,those who (DSM).
are not eligible for any type of federal, state,
or private health plan, and the medically indi- Mental Health Crisis Services- The customer
gent receiving statutorily-required services is generally an individual, family member(s)
under Section 17000 of the Welfare and Insti- or concerned person who is seeking counsel-
' tutions Code of the State of California. We thg or some type of psychiatric intervention,
provide care to many of the members of the including medications for psychiatric symp-
Contra Costa Health Plan, including commer- toms. These clients may have dropped in,
' cial members, County employees, and Medi- been advised by another practitioner to come
Cal eligible persons mandated to choose a in, or on a W&I Code 5150.
health plan under the state's Medi-Cal Man-
aged Care Program. Public Health
Mental Health The core Public Health programs of commu-
nity health assessment, communicable disease
Adult/Older Adult Program - Customers are control, and community-based prevention ac-
adults who are functionally disabled and who tivities such as tobacco control, AIDS preven-
tare seriously and persistently mentally ill; tion, community and domestic violence pre-
older adults, 60 years and over,who require vention, and chronic disease control and pre-
specialized services due to functional impair- vention serve the entire county population.
ment or significant changes in behaviors re- Public Health Clinic Services target the Medi-
tated to a serious, persistent mental illness; Cal population,the working uninsured, and
1 and persons who are in severe crisis or are in the indigent population. Other programs focus
danger of suicide, hospitalization or becoming on specialized populations: Family, Maternal,
seriously and persistently mentally ill. Cus- and Child Health on women and children, Se-
tomers are generally Medi-Cal recipients or nior Nutrition Project on all persons over 65,
Medi-Cal eligible, or have no health care cov- and the Miller Centers on developmentally
erage. Access to service happens through an disabled adults and children.
1 individual provider or crisis service and then
through a centralized assessment/authoriza-
tion process. Community Substance
Abuse Services
Children's Services-Eligibility for services
in the public mental health system is deter- CSAS client data reports show between July
' mined by various pieces of state and federal 1, 1995 and October 31, 1996 there were a to-
23
tal of 2,750 clients who were admitted and Emergency Medical ,
discharged from non-methadone residential
and outpatient treatment programs; 5 3.1% ServiC6S
were males and 46.9%were females. When EMS serves county residents and all other per- '
methadone clients were excluded from the sons working or temporarily in the county
analysis, drugs of choice most commonly re- . who need the assurance that an emergency
ported by clients were: 46.3% alcohol, fol- medical response system is available should ,
lowed by methamphetamine (22.8%), cocaine/ the need arise in the event of day-to-day emer-
crack(18.2%) and heroin(5.1%). gency oi•disaster. These include: victims of
sudden medical emergencies needing the rapid ,
Contra Costa Health Plan response of trained emergency medical pro-
CCHP seeks to serve the special needs of vul- viders to perform emergency treatment and to ,
provide transportation to the appropriate hos-
nerable populations. It is available to Medi-
Cal and Medicare recipients, employees of Pital emergency facility; patients subject to
interfacility transfer; as well as emergency re-
participating private and governmental em- ,
sponse personnel, advanced life support(ALS)
ployers and individual members of the general
program managers who need program ap-
public. It currently serves over 55,000 people proval by the EMS Medical Director; EMT-I ,
living in Contra Costa County. and`paramedic training program managers;
and EMS providers and other emergency re-
sponders who rely on a well organized,profes- '
Our ultimate customers are the general popu- sional EMS system as one component of the
lation of Contra Costa County who rely on ap- county's overall emergency response system.
propriate inspection and regulatory activities '
to protect their health. More specific custom-
ers include the businesses and individuals
whose activities fall under our jurisdiction.
Hazardous Materials ,
Programs
Hazardous Materials Programs serve the entire ,
community of Contra Costa County by over-
seeing the handling, processing and storing of
hazardous materials by business. Businesses '
and individuals handling hazardous materials
are the more specific customers of our pro-
grams.
24 '
1
1
••V• Customer R ips
efations
Each division has a unique blend of relationships with clients as evidenced in
outreach and-utilization. Programs vary in.their ability to choose clients. Some
1 programs have very specific eligibility requirements, while others are open to all
who come for services.
' Hospital & ority in a patients' needs assessment survey.
Health Centers A post"Patients' Choice" implementation
study conducted in the spring of 1997 showed
' The majority of our patients use our service increased patient satisfaction with access to
because we are the health services of choice. short notice primary care.
With.the advent of the state's mandatory
Medi-Cal Managed Care program in 1997, The division conducts ongoing inpatient satis-
specified Medi-Cal eligibles choosing the faction surveys and'annual outpatient satisfac-
Contra Costa Health Plan may identify tion surveys. For inpatient services, staff assist
' Merrithew Memorial Hospital and Health patients in completing a survey that focuses on
Centers as their health care provider. For their care and stay at the hospital. We cur-
indigents enrolled in Basic Adult Care,we are rently receive an average of 400 surveys a
the only available option in the county. Pa- month. Similar patient satisfaction surveys are
tients are informed about our services through conducted in the Ambulatory Care Health
' a variety of formal and informal mechanisms. Centers annually to identify patients' concerns
Formal mechanisms include marketing mate- and to ensure that operational interventions
rials developed by CCHP, notices posted in developed and implemented have been effec-
t other county-wide departments, through So- tive in the eyes of the patients. Inpatient and
cial Services for patients who must choose a outpatient satisfaction surveys are analyzed
health plan under Medi-Cal Managed Care, and incorporated into the division's strategic
1 relationships with a host of county-wide com- plan and appropriate operational interventions
munity-based organizations, service organiza- are developed and implemented to correct
' tions, religious organizations and numerous problems identified by our patients.
public guides to services. Informal mecha-
nisms are primarily"word of mouth."Persons Mental Health
' enrolled in CCHP are given orientation and
marketing materials which describe the ser- Adult/Older Adult Program. -In the past year,
vices, hours of operation, and points of con- as programs have been redesigned to better
' tact. meet clients needs, services involving natural
support systems are more available in the
Access to ambulatory care services has been community. Staff are spending more time out
improved tremendously by the Patients' of the office in the community, becoming fa-
Choice Program. Patients' Choice allows pa- miliar with natural support networks, building
tients to make same and next day appoint- stronger relationships with local businesses
ments for primary care upon request. In 1995, and citizens, and becoming a part of commu-
patients identified improved access to short nity organizations that they can influence on
notice appointments as their number one pri- behalf of clients. Client satisfaction, as mea-
25
sured by standardized satisfaction question- sites throughout the county. In addition,Pub- '
naires,will be administered regularly as soon lic Health Outreach Workers find clients in the
as the State Department of Mental Health communities, including IV-drug users with
makes a decision about the format and over- AIDS,pregnant women and homeless per- '
sight of the performance outcomes process. sons. Public Health services are brought to
community settings through Health Care for
Children's Services. - Target population chil- the Homeless, Health on Wheels Mobile
dren and youth are identified, screened, and Clinic Van, Home Health Agency, and Public
referred at various "portals of entry" into the Health nursing. Public Health prevention
system of care. Fees are charged using a state- programs are implemented through partner- ,
wide system and are based on ability to pay.A ships with community-based organizations
significant proportion of clients are on Medi- throughout the county. The Homeless
Cal and thus pay nothing for services directly. Ombudsperson evaluates client satisfaction '
For court dependents, entry is through the with homeless services county-wide. The
Emergency Placement System(EPS),which is Public and Environmental Health Advisory '
comprised of a number of emergency foster Board and community partnerships provide
group homes. For special education students, feedback on community-based services.
the portal of entry is initially the school, and '
secondarily the screening unit of the AB3632 Community Substance
Program. Other seriously emotionally dis- Abuse SenAces
turbed(SED)youngsters may enter the system '
via one of the three regional clinics,the Clients are required to pay for treatment ser-
vices. However, no client is denied services
County Psychiatric Emergency Services Unit
(E-Ward), or one of the local acute inpatient based on inability to pay. Payment is based on '
units. Administration of a parent satisfaction a sliding fee scale which assesses total house-
survey began in 1997 as part of statewide hold income.
implementation of performance outcomes in ,
Children's Mental Health Services in Califor- Most clients gain access to services simply by
applying to community or county operated
nia.
programs,provided the primary problem is '
Mental Health Crisis Services. - Those re- substance abuse. Criminal Justice Treatment
questing services are evaluated and treated or Program clients are referred through programs
given recommendations and referrals to the ap- such as DUI or Diversion Programs. Preg-
propriate service for care. Customers gain ac- nant and parenting women are referred by out-
cess to services through look-up telephone di- reach staff, case managers, and county-wide '
rectories, hotlines, consumer publications, in- provider coalitions with specific goals to im-
formation and referral line through CCHP, ad- Prove perinatal outcomes.
vice nurses and other triage personnel in vari- '
ous hospitals and clinics,police departments Services are located regionally throughout the
county. CSAS staff coordinates with many
and other public agencies. We are preparing a
satisfaction survey to be given to all clients re- community and county agencies,to provide
ceiving crisis services.
service to individuals affected by substance
abuse.
Public Health Lasts were ear customer satisfaction surveys Y
Public Health clients gain access to Public used in all county operated programs. In addi-
Health services through the clinic and service '
26 '
tion, CSAS has established three customer sat- vices are provided to all without regard to
isfaction hot lines, one of which is staffed by ability to pay or insurance status. Funding
Advisory Board members. The Customer Ser- through CSA EM-1 is available to EMS sys-
' vices Telephone Line in the CSAS administra- tem participants for enhancements in the level
tive office allows clients to anonymously of emergency medical services provided. The
voice complaints and make recommendations EMS Agency relationship with some custom-
for better services. ers is regulatory in nature at times. Hospital
interfacility transfers of emergency patients
Contra Costa Health Plan are monitored. The EMS Medical Director
' CCHP regularly surveys its members, and will credentials and provides medical oversight for
conduct a member survey later this year. An- emergency response personnel. The EMS
other measure of members satisfaction is the Agency approves and monitors all advanced
rate of those who disenroll voluntarily. That life support provider programs and prehospital
number is 18% lower in fiscal year 1997 than training programs operating within the county.
' the previous year.
The EMS Agency has placed a high priority
As CCHP also considers its providers as cus- on maintaining good customer relations
' tomers, it will be conducting provider satisfac- through its day-to-day handling of customer
tion studies of both staff providers and the inquiries/complaints and in annual evaluations
new community provider network in 1998. of the ambulance services. EMS publishes a
monthly newsletter to enhance communication
Accessibility to specialty care is a major focus with EMS and allied personnel and agencies.
of attention for both customers and providers
' of managed care. CCHP patients are routinely The EMS Agency promotes customer satisfac-
referred to out-of-plan specialists if a Health tion at all levels - the public,the patients and
' Center appointment is not available within the the provider personnel and agencies. Feed-
time specified by providers. Additionally, back is received anecdotally through participa-
CCHP has taken steps to enhance its mem- tion in various groups and meetings and from
' bers' access to specialty services within the occasional public inquiries regarding ambu-
County's health centers. lance services. No formal program to measure
customer satisfaction has been undertaken.
' Emergency Medical
Services
EMS services are available county-wide. The
EMS Agency plays a lead role within EMS
' services coordination among EMS providers
and other emergency responders. Property
owners pay an annual assessment to CSA
EM-1 to maintain availability of enhanced
' EMS services. Victims of sudden medical
emergencies pay for emergency ambulance
' service; Medi-Cal, MediCare, and private in-
surance cover the majority of patients. Ser-
27
•'• Performance Indicators
The approach to performance indicators is changing. Most used to focus on the
program/system/institutional measures of inputs — how many visits provided,
shots given, permits approved. Some of those measures remain relevant, but we
' are moving toward identifying the outputs, or outcomes of the activities,focusing
on the effects on patients/clients/customers. This process is complex. Each Divi-
sion, especially those with multiple programs, is examining what should be mea-
sured. In addition, many programs are directed by regulatory agencies which
specified the desired measures.-For specific comparisons of data in FY 1995-96
' and FY 1996-97, see Attachment C
Hospital & Mental Health
' Health Centers AduldOlder Adult Services-A Performance
This division has developed multiple indica- Outcome Study was initiated in 1994 and re-
tors and outcomes to monitor and improve sults were analyzed recently by the Mental
quality and patient satisfaction. Some are de- Health Commission. Eleven of the perfor-
termined by regulatory agencies, such as the mance outcome measures were used as key
' Sindicators. In Contra Costa County, only two
State Department of Health Services Licens-
ing Division, and the Joint Commission of of the six domains showed results signifi-
Accreditation of Healthcare Organizations. cantly different from the state-wide average:
Examples include: living situation was below the average and en-
Examples
Average length of stay gaging in productive daily activity was above.
Patient satisfaction In addition,we will be looking at performance
• outcomes such as reducing state hospital bed
• Emergency Department utilization
Cost per patient per day days, WD beds, acute hospital beds, improve-
• ment in living situation, educational activities,
• Number of Ambulatory Care Visits per
month by site work status, and decreases in alcohol and/or
• Medical and nursing staff quality assur- drug use.
' ance monitoring
QA monitoring by ancillary departments Children's Service Program -Legislation re-
QA that all counties report data on perfor-
mance measures adopted by the California
' 29
Mental Health Planning Council of the State Highlights of the data collected show that
Department of Mental Health. A multi- 16.6% of clients complete their treatment
method approach has been adopted to meet plans. Of those clients who exit treatment
these requirements. The outcomes to be mea- early, less than half(42.1%) leave treatment '
sured fall into two general categories: 1-sys- with"unsatisfactory progress", 9.5% leave
tem level measures and outcomes, and 2-con- with"satisfactory progress"and 20.4%were
sumer level measures and outcomes. Many transferred to other treatment providers. '
standardized instruments are used to measure,
assess and suggest treatment goals. Contra Costa Health Plan
CCHP regularly monitors utilization and en-
Public '
Health rollment trends for each of its major groups
Public Health evaluates performance by look- and reports results on a monthly basis to the
ing at community health indicators such as in- Managed Care Commission.
fant mortality, utilization of early prenatal
care, and tuberculosis rates. Clinical Services Environmental Health '
are evaluated by process measures including Annual Division Program Plans identify the
number of clients served, cost per unit service, total workload of all programs and set activi-
and staff productivity measures. The Public ties for each program. Individual staff mem-
Health Data and Evaluation Unit has been bers complete Annual Performance Evalua-
charged with developing more targeted out- tions that include the identification of activi- ,
come evaluations of Public Health programs, ties they plan on accomplishing during the
especially Family, Maternal, and Child Health
year. Standards for the solid waste medical
programs and the county's programs focusing waste., small water system and detention facili- '
on the homeless. ties are established by the appropriate state
agency and ongoing state Local Enforcement
Community Substance Agency(LEA) certification is dependent on '
Abuse Services meeting the state standards. In the retail food
CSAS developed thirteen major indicators to and consumer protection programs, standards '
monitor the effectiveness of the Division's of service are based on state guidelines and lo-
prevention efforts. The CSAS focused most cal ordinances.
of its prevention work on alcohol-related ac- ,
Hazardous Materials
tivities and policy initiatives, and the perfor-
mance indicators reflect these efforts. During Programs
FY 1997-98, CSAS providers and programs The Division is responsible for implementing
are required to collect process and outcome regulatory oversight of hazardous materials
indicators. '
under,various State and County laws. Toward
this end inspections, training, investigations,
Treatment outcomes measure length of time reporting, and enforcement activities are
in treatment as well as discharge status when a tracked and documented. While the Division's
client leaves treatment. The majority of goal is to protect the health of the community
CSAS clients were in outpatient treatment safe erformance is measured b the number
(53.9%), compared to 46.1% of clients in resi- 'p y '
of incidents impacting or threatening commu-
nity health and safety.
30 '
A statistical study, recently concluded for cal-
endar years 1989 through 1996, shows that for
this period of time there were an average of
five (5)major incidents per year with an an-
nual range of between 2 and 9 incidents.
' There has been no statistical significance in
the increase or decrease in the number of inci-
dents affecting community health and safety.
Emergency Medieal
Services
Emergency Medical Services statistics are
monitored in five areas: ambulance services
and air ambulance services (primarily patient
stabilization and transport systems); trauma
' services and first responder defibrillation ser-
vices (triage,"saves" and trauma services);
and inter-facility patient transfer review ser-
vices (general oversight of patient transport).
Utilization statistics and trends are compiled
for each area on a regular basis, including the
' number of units dispatched, average response
times,number of patients transported and the
number and type of"saves".
1
1 31
1 ❖ Accom fis ments
Hospital i l
& • Developed new format for the required
1 Health Centers Safety/Infection Control Review Training
• Continued success and improvement of that significantly reduces training costs.
"Patients' Choice Program." Same/next
1 day appointment capacity increased from Mental Health
11% of family practice appointments to Children's Services
1 68%; reduced the percentage of patients Implementation of programs funded by
who do not show up for their appoint- AB3015,the California System of Care
ments; reduced Emergency Department Contract to reduce group home placements
Utilization. in the county. These programs include a
collaborative effort with the Probation De-
0 The "Patients' Choice Program"was hon- partment to provide day treatment, residen-
tored with two awards -the 1996 California tial, and educational components to youth.
Association of Public Hospitals' Manage- In addition,the Intensive, Intermittent In-
ment Excellence Award and the 1997 Na- tervention program(I'P)works with the So-
1 tional Association of Public Hospitals' cial Services Department.
Safety Net Award for Innovation.
• Expansion of children's mental health ser-
e Hospital and Health Centers Lab received vices through receipt of EPSDT (Medi-
full accreditation from the Joint Commis- Cal) funding.
sion on Accreditation for Health Care Or-
ganizations. Adult Services
• Adult Services put out a Request for Pro-
t • Full accreditation of cancer program. posals for 54 new augmented board and
care beds. Twenty-four of these beds will
• Full accreditation for Family Practice become available in the next few weeks.
tResidency Training Program. Consumers are ready to be discharged
from IlVID placements into these beds.
• Implementation of a successful Psychiatric This will represent.a savings of approxi-
Outpatient Day Treatment Program that mately $800,000 in residential costs.
expands the continuum of care for psychi-
atric services and focuses on teaching pa- Developed a collaborative effort with the
' tients skills they need to live in the com- Community Substance Abuse Services Di-
munity vision,to apply for a federally-funded
t grant which was received. This grant
• Implementation of computerized Order fuding will to provide intensive case man-
Entry system and Radiology Reporting agement services to consumers who have
t through the MediTech system, improving concurrent mental health and substance
efficiency and access to necessary medical abuse diagnoses in West County.
information by staff via the computer.
1
33
• A Vocational Services Coordinator posi- Five free sealant clinics were held county- '
tion was fully implemented in June 1997. wide which provided 1,246 free sealants to
The cooperative contract with the Depart- 270 children at an in-kind value of over
ment of Rehabilitation(DR)was reestab- $50,000. '
lished for 1997-98. This contract provides
two FTE counselors County-wide, evenly A portable dental unit was donated by-the
divided among the three regional DR of- State Oral Health Needs Committee and
fices. (Each office has a designated DR/ --the Mt. Diablo Dental Hygiene Society.
MH contract counselor.) The contract This unit will be used to provide preven-
provides case service dollars for supported tive dental services to children at school '
employment,job development, placement sites.
and job coaching, vocational training, and '
supported education. Services are sup- Women Infants& Children
plied by community agencies as vendors. (WIC) Program
• Received awards of recognition from the
Public Health California WIC Association in the catego-
ries of: "Monumental Program Growth",
Senior Nutrition and"Innovative Outreach".
Added one Home Delivered Meals (HDM)
route in Pleasant Hill/Concord area. Expanded Received multiple state authorized
scope of HDM provider contract to include caseload increases throughout the year tak- ,
AIDS patients. Raised$40,000 in public con- thg the caseload from 13,400 to 16,500 at
tributions to purchase meals for homebound year end, a 23% increase, based on dem-
elders. onstrated successful outreach and expan-
sion performance after each incremental
George Miller Centers-East& West increase during the year.
Implemented an after school program which is
expected to be at full enrollment by December Implemented on-line communication with
1997. The centers provide social recreation the state WIC computer system in Decem- '
and day care programs serving those with spe- ber, inputting 10,000 client family records.
cial needs between the ages of 11 and 22 System includes performing client certifi-
years. Home infant services have also cations and appointment scheduling on ,
doubled from last year. lime.
Dental Program Family,Maternal, and Child Health
• Since opening in April 1996, over 200
children have received dental services at Perinatal Services Program
Parkside elementary school's dental clinic, The Perinatal Services Program has '
a partnership with the Healthy Start Pro- worked closely with both Managed Care
gram, Pittsburg Unified School District, Plans in development of work plans to
and the Contra Costa County Dental Asso- guide the daily implementation of compre- '
ciation. Volunteers continue to support hensive perinatal services. A collaborative
this clinic. A new Healthy Start dental data project,Managed Care Perinatal Out-
clinic is scheduled to open in 1998 at comes Project, is close to the piloting '
Peres elementary school in Richmond. stage.
34
• Continued to focus efforts on priority ar- Increased by 10%the number of children
eas relative to improving perinatal out- screened for wellness care. This increase
comes in Contra Costa County such as do- represents a total of 4,000 children above
mestic violence,tobacco cessation, food the number reported in FY 96-97.
access, and lactation support.
Public Health Laboratory
• A new program, Perinatal Outreach En- • Started performing TB tests for Martinez
hancement,was funded. This program Veteran's Clinic and Mt. Diablo Hospital.
' focuses on reaching hard-to-reach popula-
tions in order to increase access to early • Implemented more sensitive molecular bi-
and continuous perinatal care. This pro- ology-based testing for STD's, MTB, and
' gram also provides a variety of activities HN
to increase education and access to cultur-
ally appropriate tobacco cessation services • Implemented oral fluid testing for HIV
' including free acupuncture services as an outreach programs.
adjunct to group counseling and case
management services. • Implemented Hepatitis C antibody screen-
ing.
California Children's Services (CCS)
• Developed and implemented procedures Public Health Clinic Services
' for effective case management and utiliza- • Received funding from a state grant to
tion review activities with the County's participate in collaborative pregnancy pre-
two Medi-Cal Managed Care Plans. vention efforts in West County.
• Developed and implemented on-site • Developed a Teen Health Corps at Rich-
Medi-Cal utilization review at Children's mond High School to involve young
Hospital Oakland. people in health-related activities and
steer them toward health careers.
1 • Increasing media and community aware-
ness of the CCS program and increasing Worked collaboratively with Richmond .
on-site utilization review activities at High School's Health Academy and Rich-
other hospitals. mond Health Center's Pegasus Project to
develop a health career mentoring pro-
Child Health and Disability gram for high achieving students.
' Prevention Program (CHDP)
• Implemented a second-hand smoke pre- Worked with the County Office of Educa-
vention project with families where chil- tion to enhance the curriculum for classes
dren are exposed, by history,to tobacco at Juvenile Hall.
smoke. This project targets children birth
' to age 5. Expanded number of Immunization Clin-
ics and clinic sites with more comprehen-
• Implemented an anemia prevention and sive accessibility to the community. In ad-
high iron intake project among children dition,held weekly employee immuniza-
with blood values below those recom- tion clinics.
mended by the Academy of Pediatrics.
35
• Continued weekly Breast Cancer Screen- nated and that parents know which immu-
ing Clinics in East, Central, and West nizations their children need and where
County. Initiated Breast Cancer Screening and when to go to get them.
outreach and follow-up on identified prob-
lems. Mobile Clinic Services provides a mobile
clinic for West county residents four days a
• Worked with Mt. Diablo School District, week. Services include: limited primary
to apply for and receive a Healthy Start care, STD services,Family Planning, HIV
grant which will expand health programs testing and counseling,TB testing and im-
for the Monument Blvd. corridor in Con- munizations. This clinic is provided '
cord. through a cooperative agreement with Kai-
ser and Brookside Hospital. A new mobile
• Bay Point Community Wellness Center clinic van will be purchased with funds '
opened as a combined center for Well provided by Chevron.
Child and Pediatrics under Public Health
as well as primary care under Hospital and Home Health Agency
Health Centers. Increased nursing productivity by 11% and
increased patient visits by 13%, while re- '
• Increased surveillance of identified health ducing annual program costs (i.e., County
problems from PAP reports. subsidy)by over 82% from FY 95-96.
• Established& implemented training for Community Wellness
low income youth on health related issues. & Prevention Program
Healthy Neighborhoods Project
• Developed a Quality Assurance Program In its second year,the Project mobilized
for Public Health Clinic Services. communities in East and West County to
embrace the Healthy Neighborhoods con-
Acute Communicable Diseases cept and gain funding for a Lead-Safe pro-
Immunization Registry implemented a gram which will be implemented next
software program which registers immuni- year. ,
zations received for children ages 0-2 and
eventually 0-21, at all Public Health Clin- Tobacco Prevention Project
ics in the county and at Pittsburg, Bay Launched the Youth Mobilization Project,
Point and Brentwood Health Centers. a youth-driven project aimed at reducing
Currently the immunization records of tobacco advertising and youth access to to- I over 60,000 people have been entered into bacco. Released Tobacco-Free Youth
the registry. This system will ultimately policy paper to provide basis for model
include data for all community providers Ordinance.
under CCHP, as well as private providers
who give immunizations to children and Lead Poisoning Prevention Project
elect to enroll in the system. Provided direct services to over 430 chil-
dren and their families. Assisted the City
• Immunization Outreach Cooperative of Richmond in applying for HUD funding
Project developed to insure that immuni- to ameliorate causes of lead poisoning in
zation services for children are coordi- homes occupied by children.
36
' Bicycle Head Injury Prevention Project borhoods throughout the county.
Distributed additional 2,000 helmets to
Pittsburg children and developed survey Homeless Programs
' tool to track distributed helmets and evalu- Outreach to homeless individuals, police
ate the educational component of the inter- departments, cities, and Caltrans has been
vention. developed and increased due to the pres-
ence of the Homeless Ombudsperson/Liai-
Breast Cancer Partnership son.
Provided community-based outreach to
women and families through eleven mini- Shelter Plus Care I and II have met the
grants to agencies serving women of color. HUD obligations for housing units served.
' Increased the Provider Network to 32
health care providers to institutionalize Secured Shelter Plus Care III funding to
breast health care. serve HIV/AIDS individuals.
' Violence Prevention Project The Five Year Continuum of Care Home-
* Implemented the fifth annual "Increase less Plan was developed and approved by
' the Peace"Month, with a broad range of the Board of Supervisors.
community partners and local corpora-
tions. The 1996 HUD Homeless Assistance Pro-
gram received approximately $3.1 million
• Hired a nationally recognized community dollars in funding, for seven new programs
organizer to launch the Violence Preven- to provide homeless and housing services
' tion Action Plan, which was endorsed by throughout the County.
County voters:
' • The development of a new emergency
• Developed"Tools for Ending Relationship shelter program structure that allows for an
Violence" for providers working with emergency shelter within the 90 day case
' pregnant and parenting teens. managed shelter program. This provides
the opportunity for people to come in off
Hunger,Nutrition & the streets for a 30 day respite.period.
Physical Activity Projects
• Developed three culturally sensitive, low- • The Homeless Hotline is operated 24
fat diet and exercise videos which are be- hours a day, seven days a week, year round
' ing marketed nationwide and have been so that homeless individuals who call can
shown on Contra Costa Cable TV. always speak with a person. The program
has been stabilized and has increased
• Launched a scholarship fund for low-in- credibility in the public eye.
come adults who want to participate in ex-
ercise classes;trained seven community Community Substance
' residents to dead aerobic dance and walk-
mg groups. Abuse Services
' Established an internal management-
Completed data collection for food re- planning group to initiate the development
source maps for four low income neigh- of CSAS System of Care, an integrated
' 37
continuum of care that would improve and According to the California Medical '
increase access to services, accountability, Association, CCHP has the second lowest
client and system performance outcomes. administrative costs of the 12 HMOs
operating in Contra Costa County. CCHP '
• Hired consultants to provide technical spends 92%of its revenue on medical care
assistance and training in Quality Manage- and only 8%on administration. Within
ment and Learning Organization prin- the State of California, CCHP is the fourth '
ciples, concepts and practices. lowest of 47 HMOs.
• Presented a framework for the CSAS Environmental Health
System of Care Initiative to the Board of The mobile food preparation unit(Vehicle
Supervisors. •
inspection)program received increased
Created a planning process to ensure attention, and many of the units that were
• operating without permits or inspections
inclusion of client and consumer perspec- were brought into compliance. ,
tives, and providers from mental health,
public health,hospitals and clinics, in the The California Integrated Waste Manage-
development of CSAS System of Care.
ment Board reviewed the annual documen-
Effective January 1, 1998,the CSAS will tation required from the Local Enforce-
• implement an integrated system of care to meat Agency(LEA), and voted to recertify
deliverP revention and addiction treatment the LEA. '
services to county residents. The Medical Waste Management unit of
the Department of Health Services (DHS)
Contra Costa Health Plan conducted an on-site program review and
• Between July 1996 and June 1997, enroll- granted program recertification. Permis- '
ment in CCHP grew from 24,706 to sion was granted to DHS to use some of
55,323 members. The growth reflects the Medical Waste program policies and
increases in the AFDC Medi-Cal mem- procedures for models to other county
bers,who are now 78% of CCHP's total LEAs.
enrollment. This increase is a direct result
of the implementation of the Two-Plan The Office of Drinking Water, Department
Model for Medi-Cal Managed Care in of Health Services conducted an on-site
Contra Costa County. program review of the Small Water Sys- '
tems Program and granted recertification
• CCHP expanded its provider network to to the LEA.
accommodate the increased membership.
It established as,one of its programs the Hazardous Materials
CCHP's Health Partnership for Medi-Cal. The HazMat Program recently became
This partnership consists of our Hospital '
&Health Centers,Kaiser and community the Certified Uniform Program Agency
physicians and hospitals including Planned (CUPA)for all of Contra Costa County.
Parenthood. The Division will be directing efforts
toward fulfilling the legal and regulatory
requirements of these programs.
38 '
' Emergency Medical Funding was obtained from the State to
Services support the role of the Contra Costa
County Health Officer as the Regional
• A comprehensive new Emergency Medical Disaster Medical/Health Coordinator for
Care Committee "standing committee" the Northern California Coastal Region.
structure was developed and implemented . Emphasis was on setting up procedures for
' to begin an ongoing evaluation of EMS facilitating disaster medical response
system performance and to make recom- within the region.
mendations for future action. This evalua-
tion will be made based on standards. Oversight and medical direction for the
identified in the County EMS System Plan EMS first responder defibrillation program
approved by the Board of Supervisors in was provided. Under this program, all
' 1995. EMS areas being addressed include firefighters county-wide are trained and
system organization/management, staffing/ equipped to use automatic defibrillators to
' training, communications, response/ provide electric shock to heart attack
transportation, facilities/critical care, data victims. During 1996, 461 patients in
collection/system evaluation, disaster cardiac arrest were evaluated for treat-
medical response and public information/ ment, 145 treated, 35 saved for hospital
education. admission and 17 discharged from the
' The EMS Agency maintains the"1-800-
hospital.
GIVE-CPR"telephone number to make In addition to funding for the Regional
available information regarding citizen Disaster Medical/Health Coordinator
CPR training to the public. Pacific Bell project, a third year of funding from the
has included this number in telephone State EMSA was obtained for an evalua-
books for all regions of the County. tion of poison control center alternatives.
• Under the direction of the Board of Super- •
Ambulance services under contract re-
visors, initial work has been completed sponded to 46,980 emergency requests in
towards implementation of a pilot fire 1996. Of these, 34,009 resulted in patient
engine-based paramedic program in the transport to a hospital emergency depart-
Contra Costa County Fire Protection ment.
District which could make advanced life
support care available to patients prior to All injured patients were evaluated using
the arrival of ambulance paramedics. A field trauma triage criteria established by
one year engine-based first responder the EMS Agency. Of those, 852 were
program in the Bethel Island Fire Protec- transported under County trauma protocols
' tion District was begun with medical to a trauma center, usually the County-
oversight provided by the EMS Agency. designated John Muir Trauma Center.
• Standards were adopted for"Enhanced
First Responder Programs",which will
assist first responder agencies in imple-
menting and evaluating their EMS pro-
grams.
' 39
1
1
ection :V
t 4,-.c -& Ne Di tiaf noes . W rec 1 S * . '. .. .
1
•'• C affen es
The challenges to be faced by Contra Costa Health Services in the coming year
are both internal and external. The continuing growth of managed care requires
us to become more adept at managing risk, increasing quality and patient satis-
faction, and matching costs to available resources. The advent of welfare reform
brings some added responsibilities to Health Services, potentially reduces Health
Services revenues, and creates new financial pressures on the overall County
1 budget, as people lose benefits to which they were entitled previously.
The competitive health care environment re- age our fiscal and human resources to main-
quires us to be able to move quickly to hire or tain the appropriate balance between our twin
reorganize staff, to purchase equipment, and missions of comprehensive health care deliv-
to reallocate funds among budget categories. ery and community health promotion. We
1 We must also continue and expand, when nec- must increase the understanding within our
essary, our key partnerships with the private own workforce of how our various programs
sector in order to maintain or increase our enhance each other, of which programs need
' competitiveness. We must rely on leadership to become more coordinated with each other,
from our Board of Supervisors to remain ac- and of which programs need to provide better
tively involved in understanding the issues, customer service to each other. Finally,to be
exploring alternative funding possibilities, and successful, we must provide employees with
developing the necessary consensus to address the tools to negotiate successfully the changes
the challenges to come. This leadership be- we will be undergoing.
comes all the more critical if more and more
uninsured people with limited ability to pay . Our internal customer satisfaction efforts must
turn to us for their health care. be matched by greater external satisfaction
with our programs. Not only must we in-
We face a number of inter-related internal crease patient satisfaction with all of our ser-
challenges. The pressures on our public vices, but we must also increase positive pub-
health care delivery system cannot be allowed lic recognition of the regulatory, health im-
' to overwhelm our continuing need to provement and health protection programs
strengthen our community health improve- which we operate.
ment and protection programs. We must man-
1
1 41
•'• New Directions �
In order to meet our challenges, we will continue to develop new strategies in the ,
following areas:
Medi-Cal Managed Care
Medi-Cal managed care in Contra Costa Health 'Services has been forging new program
County was structured by the State to be a linkages with the Social Service Department
two-plan model: the local initiative(CCHP) to address community concerns about '
and a commercial health plan. The local ini- CalWORKS and to build the new programs to
tiative captured 94% of all members in Contra identify, assess and treat mental health and
Costa County, with Foundation Health Plan, substance abuse issues in the CalWORKS ,
the commercial plan, enrolling fewer than population, and to assist parents in obtaining
4,000 members. Currently, discussions are the necessary immunizations for their chil-
underway between the State, Foundation and dren. These efforts will continue in 1998. '
CCHP to consider implementing another
model in Contra Costa County. In addition,we continue to be concerned about
the possible "delinking" of Medi-Cal eligibil- '
Such a plan would be a variant of the County ity determination from the CalWORKS pro-
Organized Health System (COHS) and would gram. We will be monitoring State and Fed-
contract with the State to care for all Medi-Cal eral program regulations for further develop-
eligibles. Under this plan, Foundation could ments.
become one of the subcontractors under the Mental Health ,
County umbrella. This model requires federal
legislation which was introduced in November Managed Care
but will not be acted upon until the 1998 ses- As a result of the consolidation of two funding
sion. During the coming year,this effort to sources(Short-Doyle and Fee-For-Service
develop a County Organized Health System Medi-Cal funds, administered by the State De- ,
will be a major priority for CCHP as we weigh partments of Mental Health and Health Ser-
its risks and benefits in our effort to strengthen vices,respectively), our Mental Health Divi-
the public health care system. sion will operate as a Managed Care Plan. '
Mental Health will be responsible for the ad-
Welfare Reform ministration and provision of all specialty
CalWORKS, California's version of welfare mental health services to Contra Costa's '
reform,will require Health Services to de- Medi--Cal recipients. The date for implemen-
velop new programs. As part of the legisla- tation of Mental Health Managed Care is April
tion,recipients of CalWORKS are required to 1998. '
participate in designated work activities.
Work activities have been expanded to include Mental Health managed care may significantly
substance abuse and mental health services. impact the County's fiscal risk as services will
In addition, documentation of child immuniza- be expanded to a broader target population.
tions must be provided by parents. Tasks for implementation include the develop- '
42 ,
' ment of a contracted provider network and ad- tion and addiction treatment services to resi-
ministrative and technical support mecha- dents throughout the County. This system is
nisms needed to manage it. designed to increase access to services, to in-
crease accountability and to improve client
' Social Health and system performance outcomes. The three
Maintenance keys to its success will be effective automa-
tion,management of access and case manage-
Organization (SIIMO) ment of clients with multiple co-occurring
The Social HMO is planned for implementa- problems. This system has been designed in
tion late in 1997. It combines preventive, concert with County staff and contract agen-
acute and extended care for seniors into an in- cies. We expect it will lead to more effective
tegrated system. This innovative approach to use of our scarce substance abuse service re-
helping the elderly will assist them in main- sources.
taining their independence as long as possible
' and reduce the need for hospitalization and New Models for
nursing home care. It is a risk-based financing CommunityHealth
model in contrast to the current cost contract
' model for Medicare services. Under our cur- Improvement
rent cost contract, CCHP is reimbursed at cost Our Office for Service Integration will con-
for Medicare services, members pay premiums tinue implementation of model programs in
' for additional benefits, and Medicare copays east and west county to bring together primary
and deductibles. Under the Social HMO, care and community health improvement ac-
CCHP will receive a capitated rate for each tivities to address long-standing health con-
member based on a health status risk adjust- cerns in specific geographic areas. In west
ment methodology(i.e.,how ill the person is). county the effort combines the resources of
Because the Social HMO is not a cost reim- the Center for Health, Partners for Health and
' bursed program,the challenge will be to main- Public Health's Healthy Neighborhoods
tain strict cost controls and to manage utiliza- Project. In east county the Bay Point Commu-
tion to avoid the need for expensive nursing nity Wellness Center has been operating for
' home care or hospitalizations. one year as a site integrating Public Health,
Ambulatory Care, Mental Health and school
' By 1999, it is expected that the Social HMO district and community resources. The open-
could have as many as 1,000 members. The ing of the Center for Health in late 1998 pro-
program is important to Contra Costa County vides the opportunity for restructuring'pro-
' on several levels. It expands and improves the grams and resources in order to achieve com-
level of care available to our frail elderly munity health improvement outcomes. The
population. It also strengthens our health care hiring of a coordinator for the Bay Point Com-
delivery system by offering a new model of munity Wellness Center will allow for in-
service which in this day of intense competi- creased outreach and partnership with commu-
tion is necessary to maintain market share and nity residents.
financial viability.
Delivery System
' Substance Abuse Improvements
System of Care We have set two goals for our comprehensive
Effective January 1998 we will implement an health care delivery system: to increase patient
' integrated system of care to provide preven-
t43
satisfaction and to decrease costs per unit of grand Name Recognition
service. Two subgoals supplement these '
overarching goals. They are to increase staff /Customer Satisfaction
satisfaction and to increase continuity of care. Brand name recognition is a common market-
It is apparent that in order to improve our ing device in the private sector. It has become '
health care delivery system, we must better an important method for health care providers
coordinate service delivery across our divi- to distinguish their services from their com-
sions. Our public health, mental health, sub- petitors'. The competitive challenges facing ,
stance abuse, and medical care programs pro- our service delivery system warrant our devel-
vide a wide range of services and share many oping a distinguishing name and"trademark"
of the same clients. However,when a client logo in order to highlight our positive pres-
falls between programs or receives similar ser- ence in the market. A single strong identity
vices from several divisions,we have de- for the many different programs which we op- '
creased our efficiency, decreased client satis- erate will also reinforce our internal work of
faction and increased our costs. integrating services.
In order to �a waysim rove client care is co- This year, we formed the Brand Name Recog- ,
P
ordinated among the five divisions—Contra nition Task Force to help Health Services in-
Costa Regional Medical Center/Contra Costa crease positive public recognition of all that
Health Centers, CCHP, Mental Health, Public we do. The Task Force has developed a single
Health and Community Substance Abuse Ser- logo for use by all Health Services programs
vices—we have initiated the Coordinated and revamped Division names and letterheads ,
Case Management Task Force. The Task in order to promote more internal and external
Force is defming the changes necessary to in- recognition of how all of our programs are
sure that services across divisions are pro- part of one Department. Pending approval of
vided efficiently and effectively to meet client these brand name recognition tools for Health
needs in a comprehensive manner and to in- Services by the Board of Supervisors,the Task
crease satisfaction for clients and staff. Force will implement internal culture change
activities during 1998 which will allow each
California Healthy Division to define their internal customers and ,
implement changes to increase internal coordi-
Families program nation and responsiveness. These activities
California's new program for uninsured chil- will also identify Division-specific goals and '
dren is being designed by the State during the implementation plans for increasing external
next several months. We expect that CCHP customer satisfaction and positive public
will become one of several plan choices avail- recognition of program activities and services.
able in Contra Costa. We serve many unin-
sured children now through our Hospital and
Health Centers, as well as our Public Health
Well Child and Immunization services. We
will be identifying and implementing the nec-
essary program changes in order to insure our
competitiveness once parents are informed of
their choices. ,
44
1 ATTACHMENT A
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ATTACHMENT C
PERFORMANCE INDICATORS
The following data contains comparison data for FY 1995-96 and FY 1996-97.
CONTRA COSTA REGIONAL MEDICAL CENTER
' AVERAGE DAILY CENSUS
Fiscal Year 1995-96 Fiscal Year 1996-97
' 126 118
' AVERAGE LENGTH OF STAY(DAY
Fiscal Year 1995-96 Fiscal Year 1996-97
' Medical Units 4.28 4.08
Psychiatric Units 15.97 13.24
' CONTRA COSTA HEALTH CENTERS
AVERAGE MONTHLY OUTPATIENT VISITS
CENTRAL COUNTY Fiscal Year 1995-96 Fiscal Year 1996-97
' Martinez Specialty Clinics 3,610 3,549
Martinez Family Practice Clinic 3,570 3,929
Martinez Dental Clinic 309 312
Martinez Healthy Start 194 153
' Concord Older Adults 447 443
Concord Health Center 806 940
Subtotal Central County Visits 8,936 9,°326
EAST COUNTY Fiscal Year 1995-96 Fiscal Year 1996-97
Bay Point Wellness Center n/a 168
' Pittsburg Health Center 4,046 4,376
' Pittsburg Dental Clinic 313 316
Pittsburg Healthy Start 162 163
' Antioch Health Center n/a 279
Brentwood Health Center 834 828
East County Older Adults Clinic 190 167
Subtotal East Coun g�lisrts
6,2.97':
WEST COUNTY Fiscal Year 1995-96 Fiscal Year 1996-97 ,
Richmond Health Center 4,786 5,223 '
Richmond Dental Clinic 256 276
Richmond Healthy Start 142 194 '
West County Older Adult 235 238
Subtotal WestCCounty V1 1ts q
EMERGENCY Fiscal Year 1995-96 Fiscal Year 1996-97
DEPARTMENT A VERA GE
VISITS PER MONTH ,
3,339 2,870
AVERAGE VISITS PER Fiscal Year 1995-96 Fiscal Year 1996-97
MO. BYPAYMT SOURCE ,
(All Health Centers)
Medicare 2,218 2,318
Medi-Cal 7,016 7,580
Basic Adult Care 4,629 4,277
HMO 5,811 6,351
Private Pay 1,871 2,370 ,
Private Insurance 421 434
All Other 1,259 1,011 '
TotalN
23,225 24,341
ii
1
' CONTRA COSTA HEALTH PLAN
ENROLLMENT BYPAYOR May 1996 May 1997
' AFDC 10,383 40,787
Cross Over(Medi-Cal &Medicare) 469 481
Other Medi-Cal 1,190 2,946
SeniorHealth 522 479
Commercial Members 6,299 6,405
' AIM/HIPC/MRIVIIB 74 61
Basic Adult Care 5,539 4,887
Health Plan Total 24,476 56;046
' CONTRA COSTA COMMUNITY SUBSTANCE ABUSE SERVICES
TYPE OF SERVICE ' Fiscal Year 1995-96 Fiscal Year 1996-97
' Outpatient Treatment 1,295 .1,189
Outpatient Intensive 213 191
' Day Treatment
Residential Detoxification— 19 19
' Non-hospital
Residential Treatment 5,614 5,089
' 30 days or less
Residential Treatment 11 1
30 days or more
Methadone Detoxification 3,238 2,516
' Methadone Maintenance 297 240
Primary Prevention 118,071 120,897
' Secondary Prevention 2,233 1,591
Driving Under 3,446 1,825
' Influence Program
432
Total s136, 133;558.
f r
' iii
CONTRA COSTA HEALTH PLAN ,
ENROLLMENT BYPAYOR May 1996 May 1997
AFDC 10,383 40,787 '
Cross Over(Medi-Cal &Medicare) 469 481
Other Medi-Cal 1,190 2,946 ,
SeniorHealth 522 479
Commercial Members 6,299 6,405 '
AIM/HIPC/MRMIB 74 61 ,
Basic Adult Care 5,539 4,887
Health Plan
24
Total ,v
,476 56,046 ,
CONTRA COSTA COMMUNITY SUBSTANCE ABUSE SERVICES ,
TYPE OF SERVICE' Fiscal Year 1995-96 Fiscal Year 1996-97
Outpatient Treatment 1,295 1,189 '
Outpatient Intensive 213 191 ,
Day Treatment
Residential Detoxification— 19 19
Non-hospital '
Residential Treatment 5,614 5,089
30 days or less
Residential Treatment 11 1 ,
30 days or more
Methadone Detoxification 3,238 2,516 '
Methadone Maintenance 297 240 '
Primary Prevention 118,071 120,897
Secondary Prevention 2,233 1,591 '
Driving Under 3,446 1,825
Influence Program '
Total k., ; 136;432 133558.
1 Individuals served
iii ,
CONTRA COSTA MENTAL HEALTH
' AVERAGE MONTHLY OUTPATIENT VISITS
Fiscal Year 1995-96 Fiscal Year 1996-97
MENTAL HEALTH
' CLINICS
Central County 3,643 4,098
' East County 1,157 1,587
' West County 2,994 3,325
Total � }
7,794... 9,010:
Fiscal Year 1995-96 Fiscal Year 1996-97
' SPECIALTY CLINIC
E Ward- Crisis 1,833 1,901
' Specialty Children's Clinic 1,078 997
Day Treatment 3,939 3,945
Contracted Program 990 1,616
,Total �' 'r 7,840 8,459`
' Fiscal Year 1995-96 Fiscal Year 1996-97
BYPAYOR
' Medicare 1,352 1,418
Medi-Cal 7,683 9,246
' Basic Adult Care 510 432
HMO 137 187
Private Pay 208 197
' Private Insurance 448 530
Other 2,578 2,755
Total Average.Number of Visrts: s 12,916 14.7
,
' iv
CONTRA COSTA PUBLIC HEALTH '
Home Health Agency
Fiscal Year 19.95-96 Fiscal Year 1996-97 ,
NURSING PRODUCTIVITY 5.06 5.61
Average#of Visits per Day
per Nurse '
Fiscal Year 1995-96 Fiscal Year 1996-97 '
AVERAGE NUMBER OF 2,491 2,793
CONTACTS PER MONTH '
(all HIM stafn
Senior Nutrition Program '
MEALS SERVED Fiscal Year 1995-96 Fiscal Year 1996-97 '
Congregate Meals 14,215 14,374
Home Delivered 12,594 13,128
Home Delivered—AIDS 303 306
Guardian Care 687 1,017 '
(Developmentally Disabled)
Total Meals Served 27;399 ,28;x825 '
Public Health Clinic Services ,
AVERAGE CLIENT Fiscal Year 1995-96 Fiscal Year 1996-97
ENCOUNTERS
PER MONTH I I
Child Health Screening 237 258
Teenage Program(TAP) 142 153 '
Refugee Program 49 24
Family Planning/STD 471 491 '
Total Ericounfers „W 898 927'
.M .,.
v ,
Women, Infants, and Children's Program (WIC)
AVERAGE NUMBER OF VOUCHERS ISSUED PER MONTH
' Fiscal Year 1995-96 Fiscal Year 1996-97
' 15,242 16,236
CONTRA COSTA ENVIRONMENTAL HEALTH
' ACTIVITY Fiscal Year 1995-96 Fiscal Year 1996-97
Incident Response' 13 14
Complaints2 27 33
Notification' 57 54
' Haz Waste Generators4 52 52
' Haz Waste AB21854 50 49
Underground Tanks4 34 34
' Solid Waste' 749 608
Land Development' 908 909
Consumer Protection' 2,545 2,303
Nlisc General Programs 22 62
Total Units `457.: 4,11'8
' Indicates number of calls for an immediate response to a site
2 Indicates number of responses to complaints which may or may not result in a visit to site.
' 'Notifications by business that an event may result in a citizen inquiry.
4 Includes pre-,routine,and follow-up inspection,site remediation/soil samples
' Includes routine,follow-up,complaint inspections or investigations,consultation,license or permit evaluation,
direct abatement,and violation notices.
' A
1
CONTRA COSTA EMERGENCY MEDICAL SERVICES
ACTIVITIES Fiscal Year 1995-96 Fiscal Year 1996-97 ,
Ambulance Services 46,969 46,890
Total Units Dispatched ,
Air Ambulance Services 280 268
Patient Transport
Trauma Services 1069 842 '
Critical trauma patients transported '
First Responder Defibrillation Svs— 43 35
"Field Saves"(patient admitted)
First Responder Defibrillation Svs— 17 17
" System Saves" (patient discharged)
Interfacility Transfer Reviews 831 907 ,
Cases Reviewed
TotalActivrties ,, _ ` : _ ., 49,209 � t 48;959`.'
CONTRA COSTA HAZARDOUS MATERIAL PROGRAM '
ACTIVITIES Fiscal Year 1995-96 Fiscal Year 1996-97
Notifications from Industry '
(of a hazardous materials incident) 701 671
Complaints Received and Addressed 367 420 '
Number of Incidents Reported 205 213
Total Activities x n 1,273 1,304
vii '
TABLE 1 PERSONNEL
TABLE 1
' Staffing Patterns - FTE's*
' YTD YTD %
Description May 1996 May 1997 Change
' Staff by Division:
Detention 57.72 54.08 -6.3%
Public Health** 394.74 409.34 3.7°/0
' Environmental Health 73.37 73.32 -0.1%
CCS 43.81 48.81 11.4%
' Substance Abuse 71.70 70.70 -1.4%
' Mental Health 148.47 166.01 11.8%
' Homeless 0.41 0.70 70.7%
Finance 157.80 161.64 2.4%
Hospital 700.02 695.29 -0.7%
Inpatient & Crisis Mental Health 115.99 114.60 -1.2%
Clinics-Ambulatory Care 255.20 278.59 9.2%
' Clinics-Older Adults 7.86 7.77 -1.1%
Medical Staff 177.45 178.98 0.90/0
Director's Office 17.92 18.29 2.1%
' Emergency Medical Services 6.03 5.87 -2.7%
Enterprise Fund I sub-total 1,438.27 1,461.03 1.60/6
' Contra Costa Health Plan 61.66 65.19 5.7%
Grand Total 2,290.15 . 2,349.17 2.6%
*Source: HSD Monthly FTE Reports
' **Includes Conservatorship
I
TABLE 2
I
PERSONNEL
Table 2
Affirmative Action Pattern - 1997
Total Positions 2620 '
Funded
Total Positions 2155
Filled '
Total Positions 465
Vacant
_EMPLOYEE-BREAKDOWN � --T —
..: ::
Total 2155 100%
Male 501 23.2%
Female 1654 76.7% 45.2% 45.2% 0 '
White 1287 60.1% 55.6% 55.6% 0
African American 327 15.1% 7.8% 7.8% 0 '
Hispanic 219 10.2% 10.6% 10.6% .5%
Asian/Filipino/ 0
Pacific Islander 301 13.9% 9.3% 9.3%
American Indian/
Alaskan Native 21 1.0% 0.7% 0.7% 0
1
I
I
' TABLE 3
' HEALTH SERVICES DEPARTMENT
SICK LEAVE USAGE
' FY 96/97 Value of
Division Sick Leave Sick Leave Sick Leave
Hours Used Hours Earned Used (3)
' Hospital & Health Centers 94,802.10 93,372.47 $2,382,376.77
CCHP 3,086.20 3,274.57 73,760.18
Mental Health 9,860.20 11,065.44 247,195.21
Substance Abuse 5,702.60 4,611.31 102,133.57
Detention Facility 2,187.40 2,903.67 57,900.48
Public Health (1) 29,069.00 29,748.53 622,367.29
Homeless (2) 0.00 0.00 0.00
Environmental Health 5.251.50 4,886.01 129,081.87
Total 149.959.00 149.862.00 $3,614,815.37
(1) Public Health includes Conservatorship and Calif. Children Services.
'. (2) Homeless did not have direct employee expense for FY96/97.
(3) Based on average hourly rate excluding benefits.
Source:.County Payroll System Reports DA2663B and DA2663C
cAl23\pa yro1Kfy9697\s14jk.wk4
1 DU
1
I
� Contra Costa
� HealtServices Department
1
1
i Annum Per f ormance
� Review 1997
a
i
Senior Staff
- William B. Walker,MD '
Director
Wendel Brunner,MD
Director
Contra Costa Public Health
Milt Canthi
Executive Director
Contra Costa Health Plan
Chuck Deutschman
Director
Contra Costa Community
Substance Abuse Services
Mary Foran
Assistant to the Director
Pat Godley
Chief Financial Officer
Julie Kelley
Assistant for Program&Policy
Frank Puglisi
Executive Director
Contra Costa Regional Medical Center
& Contra Costa Health Centers
Steve Tremain,MD
Director
Medical Staff Affairs
Donna IFigand .
Director
Contra Costa Mental Health
Roger Wong
Director
Personnel
Table of Contents
MissionStatement ................................................................................................................. i
OrganizationChart................................................................................................................ ii
' Organization Chart Description ............................................................................................ iii
SECTION I
1 Organization Structure .................................................................................. 9
SECTION II
Resources
FinancialResources................................................................................................................ 11
Personnel Resources ............................................................................................................... 11
AffirmativeAction ................................................................................................................. 11
SickLeave.............................................................................................................................. 11
' Staff Development................................................................................................................. 12
Automation ........................................................................................................................... 12
SECTION III
Service Delivery System
' Hospitals and Health Centers ............
MentalHealth ....................................................................................................................... 15
Public Health16
.........................................................................................................................
Community Substance Abuse Services ................................................................................... 17
ContraCosta Health Plan...................................................................................................... 19
Environmental Health Program.................................................
Hazardous Materials Programs............................................................................................... 20
Emergency Medical Services ...........................
Customer Profile
Hospitaland Health Centers ................................................................................................. 23
MentalHealth ....................................................................................................................... 23
PublicHealth......................................................................................................................... 23
Community Substance Abuse Services ................................................................................... 23
ContraCosta Health Plan...................................................................................................... 24
EnvironmentalHealth ........................................................................................................... 24
Hazardous Materials Program .............
Emergency Medical Services .................................................................................................. 24
Customer Relationships
Hospital and Health Centers ................................................................................................. 25
MentalHealth ....................................................................................................................... 25
PublicHealth......................................................................................................................... 26
Table of Contents r
Continued
Community Substance Abuse Services ................................................................................... 26
Contra Costa Health Plan...................................................................................................... 27
Emergency Medical Services ...........................................................................
SECTION IV
Annual Performance ,
Performance Indicators ,
Hospitaland Health Centers................................................................................................. 29
MentalHealth ....................................................................................................................... 29
PublicHealth ........................................................................................................................ 30
Community Substance Abuse Services ................................................................................ 30
ContraCosta Health Plan ........................................................... ...................................... 30
EnvironmentalHealth........................................................................................................... 30
Hazardous Materials ............................................................................................................. 30
Emergency Medical Services ................................................................................................ 31
Accomplishments
Hospitaland Health Centers ................................................................................................. 33
MentalHealth ....................................................................................................................... 33
PublicHealth ........................................................................................................................ 34
Community Substance Abuse Services................................................................................ 37
Contra Costa Health Plan ..................................................................................................... 38
EnvironmentalHealth........................................................................................................... 38 ,
HazardousMaterials ............................................................................................................. 38
Emergency Medical Services ............................................................................................... 39
SECTION V
Challenges & New Directions
Challenges ............................................................................................................................ 41 '.
NewDirections..................................................................................................................... 42
APPENDIX
Begins After Page 42
Attachment A..................................................................HSD County Subsidy Graph i
Attachment B.................................................................. HSD Budget/FY 1997-98
Attachment C.................................................................. Performance Indicators
Table 1 ............................................................................ Staffing Patterns
Table 2 ............................................................................ Affirmative Action Pattern-- 1997
Table 3 ............................................................................ Sick Leave Usage FY 1996-97
r
Contra Costa
HMission Statement
eat Services The Health Services Department
cares for and improves the health
of all people in Contra Costa
County with special attention to
those who are most vulnerable to
health problems and their conse-
quences.
Values
' We are an integrated system of
health care services, com-
munity health improve-
ment and environmental
protection.
• We emphasize quality of ser-
vices and respect for all
who use and work in our
programs.
• We anticipate community
health needs and change
' to meet those needs.
• We work in partnership with
' our patients, cities and
diverse communities, as
well as other health, educa-
tion and human service
agencies.
• We encourage creative, ethical
and tenacious leadership
to implement effective
health policies and pro-
grams.
i _
1
r
ORGANIZATIONAL CHART
' DESCRIPTION
' HEALTH SERVICES ADMINISTRATION
Health Services Director Assistant to the Director
William Walker, MD Mary Foran
Secretary to the Director Chief Finance Officer
Darlene Allen Pat Godley
Medical Staff Affairs Director Assistant for Policy and Planning
' Steve Tremain, MD Julie Kelley
Emergency Medical Services Director Executive Assistant
r Art Lathrop to the Hazardous Materials Commission
Elinor Blake
Diversity Services Coordinator
Carl Coates Ombudsman Program
Evelyn Rinzler
1
DIVISION LEADERSHIP
Hospital and Health Centers Contra Costa Health Plan
Executive Director Executive Director
Frank Puglisi Milt Camhi
Mental Health Director Substance Abuse Director
Donna Wigand Chuck Deutschman
Public Health Director Environmental Health Director
Wendel Brunner, MD Ken Stuart
Personnel Director Hazardous Materials Program Director
Roger Wong Lew Pascalli
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' The Health Services Department is made up of the following divisions:
' Contra Costa Regional Medical Center& Contra Costa Health Centers
• Contra Costa Mental Health
• Contra Costa Public Health
• Contra Costa Community Substance Abuse Services
• Contra Costa Health Plan
• Contra Costa Environmental Health
' Contra Costa Hazardous Materials Programs
• Contra Costa Emergency Medical Services
' • Finance
• Personnel
• Office of the Director
The Office of the Director, Finance and Per- general accounting, program reimbursement,
' sonnel provide centralized administration and and special projects and evaluation.
policy direction for the operating divisions of
the Department. Personnel provides assis- The Office of the Director also includes De-
tance with recruitment, selection, classifica- partment-wide broad policy initiatives such as
tion, compensation, benefits, employee health the Hazardous Materials Commission,Partners
and employee relations. It also assures adher- for Health, Center for Health, Diversity Ser-
, ence to the provisions of the county's own vices, Office for Service Integration and the
regulations including memoranda of under- Women's Advisory Committee.
standing with the employee organizations.
We engage in numerous partnerships, through
Finance manages all fiscal functions including contracts, coalitions,-and joint efforts. Specific
billing,contracts and grants,utilization review, partnerships are described in the detailed sec-
payroll, data processing, budget, patient and tions which follow.
i
9
' Financial Resources sion of services in Antioch and Bay Point and
Contra Costa Health Services receives fiscal enhancement of the Appointment Unit Sys-
support through various funding mechanisms. tem. The Mental Health and Public Health Di-
The recommended budget for 1997-98 is visions also experienced an increase'in staff-
$381.3 million dollars, $35.6 million of which ing(11.8/o and 3.7%,respectively) due to ex-
is net county cost(Attachment A). pansion of programs and changes from tempo-
rary or contract staff to permanent staff per
Sources of funding include Medicare, Medi- agreement with Local One.
' Cal, Private Pay/Insurance, Bond Revenues, Affirmative Action
Tobacco Tax, SB855, VLF revenue, interest
income,Realignment monies(Hospital and The composition of the Health Services De-
Health Centers, CCHP); State CCS program partment staff reflects the workforce in the
(Public Health); federal and state grants, cli- community. The only minor exceptions are in
' ent fees (Public Health and Substance Abuse); the areas of Hispanic employment, which re-
Drug Medi-Cal, federal block grant, and state quire 0.5% increase in order to attain
allocation(Substance Abuse); conservatorship workforce parity. Table 2 lists the Health Ser-
fees (Conservator); property taxes (Emer- vice workforce ethnicity,parity and depart-
gency Medical Services); Inspection Fees, ment goals.Although an ethnic distribution by
Public Health Permits, Hazardous Waste Gen- job category (i.e. professional, officials-ad-
' erator Fees (Environmental Health/Hazardous ministrators,technicians) is available, it is not
Materials Program); Ryan White funding reported due to the current inability to com-
(AIDS); State-Federal Medi-Cal Administra- pare workforce distribution by job category.
' tive Activities/Targeted Case Management
(Public Health/Public Guardian), SAMSHA This year,the Department hired a full time Di-
grant funds, SSI/SSP (Mental Health); County versity Services Coordinator to carry out em-
General Funds (multiple programs.) These are ployee Affirmative Action recruitment and
summarized in Attachment B. monitoring and focus attention on creating a
culturally competent workforce, one that is
Personnel Resources well-prepared to serve our diverse patient and
The overall level of staffing for Health Ser- user population. We Will be increasing atten-
t vices experienced a 2.6% increase in 1997. tion to diversity/cultural competency training
Additions to staff this year(Table 1) included for all staff.
the Contra Costa Health Plan,which grew by Sick Leave
three employees due to continued expansion
of the Plan. Ambulatory Care Staff were in- Table 3 displays the amount of sick leave used
creased by 23.4 FTEs (9.2%) due to expan- by each Division of the Department during fis-
t11
cal year 1996/97 as compared to the amount The Department will be examining how the CQI
accrued. It is possible to use more sick leave in principles and practices might be applied in other
a year than accrued because of the year to year Divisions.
carry-over of sick leave.The average amount of '
sick leave use per FTE is 63.4 hours.The range
by Division varies from a low of 41.3 hours to a Automaton
high of 78.8 hours in the 12 month period.How- Information Systems technology plays a major
ever, the current reporting system does not al- role in supporting medical and administrative
low us to distinguish between regular sick leave staff activities. With 23 multi-user computer
and sick leave which is used up upon retirement. systems as well as hundreds of individual per-
In addition, these figures can not reveal situa- sonal computers throughout the Department,
tions where high sick leave use is related to cata- each Division has access to modern technology. ,
strophic illness as opposed to frequent short ill-
nesses. Therefore, we have no explanation for The Department Information Systems accom-
the variations by Division. Next year, we will plishments this year includes: ,
carry out further analysis of the variations in
sick leave usage in order to develop a better un- New PCP Assignment System -Due to re-
derstanding of the'current patterns. quirements for the Local Initiative (L.I.), a
new Primary Care Physician (PCP) and Pri-
Staff Development -mary Care Site (PCS) system was created and
,Performance evaluations are distributed to su- implemented. Member information is col-
lected from the State's HCO program, Kaiser,
pervisors on a regular basis and required to be the CCHP system,the Global Appointment
submitted in a timely fashion. A new monitor- scheduling system and the Keane Patcom sys-
ing system has been implemented which has re- tem;patient choices and default assignments
sulted in a substantial decrease in delinquent are then processed and updated to multiple
evaluations submitted. '
user systems.
All staff are encouraged during the annual evalu- CCHP Membership System-A new CCHP
ation process to identify training needs and to membership database was created. This data- ,
develop a plan to meet them.A system to regis- base is updated daily, from the CCHP system,
ter staff for the offerings of the County Training with each member's demographic, eligibility,
Institute is in place. PCP and PCS information. The system is ac-
The hospital has developed a number of ad hoc cessible by Windows-based PCS (Primary
committees which serve to enhance professional Care Site) as well as touch tone telephones.
standards. In particular, there is a Continuous Local Initiative Encounter Reporting- Our
Quality Improvement(CQI)Committee. There CCHP Utilization database structure was en- ,
is also a Joint Labor/Management Committee hanced to accept claims data from multiple
which serves to meet the objectives of both the sources and new programs were created to
Department and staff in a cooperative manner. produce monthly encounter files to meet the ,
With the imminent opening of the new hospital State's L.I. reporting requirements. New in-
facility,there will be an even greater reliance on terfaces for standard claims, Pharmacy claims
ad hoc task forces to ensure that all concerns 1
are addressed.
12 ,
1
and Physicians claims were created which, in Medicare Electronic Billing-Automated
addition to complying with mandated require- electronic billing programs were created to
ments, will dramatically enhance our ability capture claims information from the Keane
' to create internal PCP-level utilization re- Hospital and Clinic billing systems, for sub-
ports. mission to Blue Shield.
CCHP Claims Processing Enhancements- Data Warehouse-The data warehouse
Major enhancements were created to auto- project, a centralized relational database and
mate the calculation of"Medi-Cal rates" for decision support system, was initiated. The
' reimbursing our Community Network Provid- warehouse currently contains CCHP utiliza-
ers, and to allow capture of detail claims in- tion, membership and provider information.
formation required for L.I. encounter report- Both standard and ad-hoc real time reporting,
' ing. using Windows-based report writing tools, is
now available for Information Systems, Fi-
' Physician Utilization Reporting System- nance and CCHP staff.
Each quarter, utilization data is captured and
formatted into both Provider and Divisional New Hospital Network Implementation -A
level reports. These reports are presented in state-of-the-art fiber optics basedcommunica-
both graphical and numerical structured pro- tions infrastructure was designed and installed
files that group Providers by service level in the new hospital. The new local area net-
specialty. work(LAN) is in the process of being con-
nected to the Health Services,wide area net-
Substance Abuse Division's MIS Selection work(WAN).
-After a lengthy and exhaustive RFP and
evaluation process, a MIS vendor was chosen, PCN Eligibility Update-A daily electronic
and a project plan established,that will pro- file update process was created for CCHP
vide automated systems to each of our County members eligible for prescriptions through the
and Contractor service and administration lo- Pharmaceutical Care Network. This new pro-
cations. cess replaced the weekly batch process.
Home Health System -A major hardware Electronic Signatures for Homeless System
and software upgrade was implemented for -All medical record entries are now electroni-
our Home Health Agency. cally signed by our Public Health Nurses us-
ing password-enabled signature software.
' Targeted Case Management (TCM)-A
system was created to capture and report Help Desk on Internet- The Health Services
TCM activity to the State . designed and operated Help Desk information
and referral system is now accessible through
Health Services E-Mail Network-A WAN- the Internet.
Based E-mail network was put in place that
' provides E-mail services to employees using
PCS and networked terminals. Using the
SMTP protocol,multiple in-house E-mail
systems are set up to communicate through
our mail server.
1
' 13
� 1
t
❖ Service Defiver SNstem
The Health Services Department is responsible for providing a continuum of health
' services to county residents, ranging from direct and prevention services for indi-
viduals to environmental and public health services that protect the well being of the
entire community. HSD works cooperatively with federal, state, regional and local
' programs and the private sector to assure comprehensive systems of health care and
health protection.
1 Hospital centers are located in Richmond(primary, spe-
cialty,and ancilliary), Martinez(primary, spe-
cialty and ancillary),Bay Point(primary care),
Early in 1998, we will move from Merrithew Pittsburg(primary, specialty, and ancillary),
Memorial Hospital to our new state-of-the-art Brentwood(primary care), and Concord(pri-
Contra Costa Regional Medical Center mary care). Specialized geriatric outpatient
services are provided at the Older Adult
Our hospital is a general acute care teaching Health Centers, located in Antioch (co-located
' hospital providing a full range of diagnostic with primary care health center), Concord(co-
and therapeutic services including emergency, located with primary care health center)and El
medical, surgical,perinatal,pediatric and psy- Cerrito. The specialty care (provided at noted
' chiatric services. Ancillary services include clinics) includes dental, rehabilitation,podia-
Diagnostic Imaging, Clinical Laboratory, try, infectious disease,pediatrics, eye, derma-
Pharmacy, Rehabilitation and Cardiopulmo tology,orthopedics, urology,ENT, GYN and
nary Care. We are licensed to provide basic Hansen's Disease. A new site,the Center for
Emergency Care Services. In addition, a 24- Health,will be open in North Richmond late
' hour Psychiatric Emergency Services Unit 1998. It will combine primary care with spe-
provides psychiatric evaluation and treatment. cial health improvement programs for the sur-
The division is also responsible for the provi- rounding neighborhoods.
' sion of health care to the adult and juvenile
detention population. Mental Health
A network of nine ambulatory care centers Adult Services. Mental health services for
provide outpatient, specialty, and geriatric adults are provided through a single point of
care services. The primary and specialty care coordination and integration. The delivery sys-
tem deemphasizes institutional care and pro-
15
motes community support services. In addi- The Children's Mental Health System of
tion to regular mental health services such as Care is linked with multiple entities includ-
assessment and therapeutic intervention,the ing the school system, probation, social ser-
following services are provided either by vices, and the health care provider system.
County or contracted service providers: Day
Treatment, Crisis Residential and Adult Resi- As a result of these linkages, county-operated
-.dential,Vocational, Crisis Intervention and programs were reorganized into teams to ,
Stabilization, and Case Management/Broker- identity specialized"matrix" staff with ex-
age. pertise and responsibility for working with
multiple programs. These teams provide ,
An Intensive Case Management pilot, imple- "high end" services (typically more intensive
mented in East County last year, has success- and expensive)to consumers. This strategy
fully demonstrated a new service model which of service delivery will assist in identifying ,
has served as a catalyst for structural change gaps and strengthening services in the Sys-
in the delivery of adult care throughout the tem of Care continuum in order to maintain ,
county. The service delivery system in Central children in their homes.
and West County regional adult clinics will
change to Intensive Case Management mod- Mental Health Crisis Services Mental '
els, operating on a seven day a week, 24 hour Health Crisis Services are available to all
a day coverage basis, within the next few county residents, regardless of age or payor
months. This model highlights the provision source. This service exists as an outpatient, '
of necessary services for successful commu- psychiatric emergency and crisis service at
nity tenure,thus avoiding costly hospitaliza- our hospital 24 hours a day, and from 8:00
tions. am to :5:00 pm, Monday through Friday at ,
the West County site. These programs pro-
Children's Services. Children's mental health vide irnmediate access as a mental-health
services are provided through a newly estab- drop-b.1 service as well as a"5150"evalua- ,
lished System of Care (SOC) or continuum of tion and treatment center.
services to meet the varied mental health '
needs of children, adolescents, and their fami- Crisis Services provides Hospital Liaison
lies. The SOC (staffed by county employees staff for the monitoring of all adult psychiat-
and programs provided through contracts with ric inpatient admissions to our hospital and '
community-based organizations)provides one contract hospitals as a result of Phase I Inpa-
seamless, coordinated, and collaborative sys- tient Medi-Cal Consolidation. These staff fa-
tem for delivery of mental health services cilitate. system-wide treatment plans and ad-
county-wide. The current SOC for Children's vocate for case management for high users of
Mental Health Services consists of five crisis and acute care facilities. As a result of
county-operated programs and 16 contract Phase H Outpatient Medi-Cal Consolidation, '
programs. Six of the contracts are for residen- Crisis will be responsible for all access to
tial or hospital-based services and ten are for and authorization for services in the Adult
less intensive community-based services. Of System of Care and on an as-needed basis for
the five county-operated programs,three are services in the Children's System of Care.
regional outpatient clinics in Central,East,
and West County and two(YIACT and AB public Health
3632) are interagency programs which are
based in Central County but serve the whole The Public Health Division provides a range
of clinical services and community outreach,
county. '
16
' nutrition services and services for develop- Community-based prevention services are
mentally delayed children and adults,commu- implemented throughout the county in part-
-nity-wide prevention programs and health nership with community-based organizations.
' data collection and assessment. Those services include AIDS prevention and
Clinical services include Well Child and Pri- education,tobacco control and cessation,
mary Care Pediatrics, Family Planning, Sexu- community.and domestic violence prevention,
' ally Transmitted Diseases, Tuberculosis Clin- chronic disease control including nutrition
ics, Immunization, and HIV Testing and education and active living projects, lead poi-
Counseling. In addition,there are mobile soning prevention, and childhood injury pre-
community clinical services for.homeless vention programs. Communicable Disease
people (Health Care for the Homeless) and for Control focuses on preventing the spread.of
those who do not present for care (Health on communicable diseases in the community, es-
Wheels Mobile Clinic Van). The Home pecially tuberculosis and sexually transmitted
Health Agency provided over 31,929 home diseases.
visits and Public Health Nurses provided addi-
tional home visits and case management for A fundamental role of Public Health is to col-
. children and families. Public Health provides col-
lect data and assess the health conditions and
' services in schools through the Dental Disease needs of the community, and evaluate the ef-
Prevention Program and School-Based Public fectiveness of public health and community
Health Clinics in Richmond and Bay Point. activities to improve the health of county resi-
Clinic services are supported by the Public dents. The Public Health Data and Evaluation
Health Laboratory, which also provides refer- staff work with Communicable Disease Con-
ence laboratory services for tuberculosis, para- trol, Clinic Services, Family, Maternal, and
' sites, and other communicable diseases to Child Health, and the Community Wellness
non-Health Department providers throughout and Prevention Program to develop commu-
the county. Clinic services are also comple- nity health indicators and evaluate program
mented by Community Outreach Workers effectiveness.
working in neighborhoods and with commu-
nity groups to identify pregnant women, chil- Many of the our programs are State or Feder-
, dren in need of health Gaze,AIDS prevention, ally mandated with categorical funding at-
TB and STD follow-up and treatment, and tached to them, which defines populations to
' homeless outreach. be served and limits services to be provided.
Non-clinical direct services include Women, Community Substance
' Infants, and Children's(WIC) services which Abuse Services
provide monthly food vouchers to over 7,000
low-income women and children, and Senior The Community Substance Abuse Services
' Nutrition Services which serves hot lunches to Division(CSAS) operates and contracts for
seniors at 19 sites throughout the county and services through a community-based con-
provide Home Delivered Meals to homebound tinuum of care that stresses accountability
' seniors and people with AIDS. The George and outcomes in a culturally competent, client
Miller Centers in Richmond and Concord pro- -driven manner. CSAS focuses on three pri-
vide therapeutic services and education for de- mazy areas: Prevention, Treatment, and Spe-
' velopmentally disabled adults and children. cialized Services.
17
Prevention. CSAS provides technical assis- Wollam House in Bay Point and two of the ,
tance,training, and resources to regional sub- Ujima Family Recovery programs serve preg-
stance abuse prevention coalitions and nant and parenting women, including their
grassroots,organizations and provides staff children. Sunrise House in Concord is for both
support to the Community Partnership Forum, men and women and Thunder Road in Oak-
an alliance of local prevention groups that to- land serves youth.
gether with the Substance Abuse Advisory '
Board(SAAB) implement the county's Sub- Residential programs are 24 hours a day, 7
stance Abuse Action Plan. days a week social model environments that
require a minimum of 40 hours per week of '
Other programs with a prevention focus in- counseling and/or structured therapeutic ac-
clude Alcohol, Drug Abuse, and Perinatal tivities. Treatment includes assessment, de-
Task Force (ADAPT)_an interagency taskforce velopment and monitoring of individualized '
developed to reduce and reverse the negative treatment and discharge plans, AIDS and STD
consequences of substance use during preg- education, vocational counseling and employ-
nancy through service coordination and pro- ment referrals. To insure continued care,
fessional training. In addition, CSAS works CSAS requires formal service linkage among
with the Council for Perinatal Health to facili- various treatment modalities. ,
tate system-wide program planning,policy de-
velopment, and interventions to improve peri- Specialized Services. CSAS operates and con-
natal outcomes. tracts to provide a number of specialized ser- '
vices to address client needs. For example,we
CSAS providers allocate at least 20% of their work with the court,parole and probation
Federal Block Grant resources to primary pre- mandated substance abuse treatment and inter- '
vention activities. CSAS contracts with com- vention services which include the county-
munity-based agencies to provide information wide Driving Under the Influence program;
and referral services, education and refusal Drug Diversion, state and federal parolee/pro- '
skills training, youth alternative activities, bationer programs; and Supervised Treatment
school based education, early intervention, And Recovery Services (STAR)in Richmond.
and support groups.
Other specialized CSAS services include the
Treatment. CSAS operates three county-run Methadone program (Bay Area Addiction Re- ,
drug-free outpatient substance abuse treatment search and Treatment, Inc.(BAART))to pro-
programs and contracts with several outpatient vide methadone maintenance and detox for
services throughout the county. Recovery sites heroin addicts; services to pregnant and '
in East and West County also provide services parenting women such as Born Free,which
to pregnant and parenting women. provides outreach, intervention, and case man-
agement; and the Council for Perinatal Health
Residential services are provided by one (CPH)a joint effort with Public Health's Fam-
county-operated residential treatment facility, ily,Maternal, and Child Health program to fa-
Discovery House, in Pacheco and contracts for cilitate system-wide program planning,policy '
residential treatment and transitional housing development, and interventions to improve
services with Neighborhood House's Fauerso perinatal outcomes; and Vocational Services.
Recovery Center in Richmond, and Bi-Belt's
Diablo Valley Ranch in Clayton. These pro-
grams only accept male clients. Bi-Belt's
18 '
CSAS services are defined to a great extent by Retail Food Protection Program is charged
the funding sources, State or Federal, which with assuring that purchased food is whole-
support them. some, and that it has been produced under
conditions and practices that are safe and sani-
Contra Costa Health Plan tary• The program inspects over 4,000 restau-
rants, markets, bakeries, schools, vehicles, and
Contra Costa Health Plan (CCHP) is a county- caterers in the County. The program also does
operated, state-licensed, federally-qualified routine and complaint sanitation inspections
Health Maintenance Organization(HIVID). It for detention facilities,juvenile facilities, and
utilizes Health Services Department programs massage parlors.
for most of the health care provided to its
members. These programs include services of Consumer Protection Program ensures that
' the Hospital and Health Centers, Public Health the County's food and water are safe and sani-
(immunizations, CHDP services), Mental tary; public recreational and public swimming
' Health and Substance Abuse services. pools and spas are free of safety hazards and
disease; and that new and remodeled food and
CCHP uses community hospitals and provid- pool facilities are constructed to assure com-
ers for services not offered through our own pliance with appropriate laws and regulations.
Health Services Department, (e.g., open heart With over 1,500 public pools and spas, 160
surgery) and as back up for selected county small water systems, 260 construction plans
' services (e.g., optometry, dental). In addition, submitted annually, 300 annual temporary
in emergencies, members may use community food events, and 240 mobile food preparation
hospital emergency facilities. The Contra units,the staff provide routine and complaint
' Costa Health Plan Local Initiative for Medi- inspections, plan check for proper design,
Cal program contracts with Health Services, as ventilation,plumbing, and auxiliary structures,
well as traditional Medi-Cal community pro- education, and event oversight to ensure com-
viders and Planned Parenthood for primary pliance. The responsibility for recreational
care and with community specialists and hos- health(such as pools and spas), retail food as
' pitals. Kaiser Health Plan is also a subcontrac- well as the mobile and temporary food units
for for Medi-Cal. are mandated to the county environmental
health unit by state law. Either the county or
' As a state-licensed, federally qualified HMO, the state Office of Drinking Water must pro-
CCHP is subject to both federal and state re- vide the small water system program. The
quirements for the level of benefits given to county has been certified as the Local En-
members. The state and federal governments forcement Agency. Drinking water laws are
impose additional benefit requirements for established at the state level and must be
AFDC, other Medi-Cal and Medicare mem- equivalent to or more stringent than federal
' bers. water laws.
Environmental
Land Use and Development Program safe-
Health Program guards and promotes the health and well being
Environmental Health provides administrative of the public through the application of envi-
' support and oversight to programs which ad- ronmental health principles to effective land
dress the environmental components of health use. Staff of the program review some 500
throughout the county. land use proposals annually; issue over 200
' on-site wastewater disposal system permits
' 19
annually and inspect their construction or also a local option program, and the Contra '
abandonment; respond to complaints about Costa County LEA has been designated and
broken sewer laterals or mains and failing sep- certified by the State Department of Health
tic systems; and monitor the activities of sep- Services to enforce all state and local laws and '
tic tank and other vehicles for liquid disposal. regulations pertaining to owners and operators
The private well construction or abandonment of medical waste generating facilities. The
program staff permit and inspect over 1500 staff is responsible for permitting and inspect- '
individual water wells, soil borings and ing sixty-seven permitted facilities and over-
groundwater monitoring wells annually to en- seeing the activities of 500 small generators of
sure they are properly constructed, main- medical waste annually. '
tained, and destroyed. State law mandates re-
sponsibility for these programs, and local ordi- Hazardous Materials ,
nances used in the program must meet state programs
minimum standards.
As the State Certified Uniform Program ,
Solid and Medical Waste Management Pro- Agency (CUPA)for all of Contra Costa
gram protects the health, safety and well-be- County, staff of the Hazardous Materials Pro-
ing of the public and preserves and improves grams provide oversight, guidance, investiga- ,
the quality of the environment by assuring tion and enforcement of the laws involving
proper storage and disposal of solid waste. A the handling, storage and processing of haz-
local option program, the Contra Costa ardous materials in order to assure that the '
County Local Enforcement Agency(LEA)has health and safety of the community is not
been designated and certified by the California jeopardized.
Integrated Waste Management Board to en- ,
force all state and local laws and regulations Hazardous Waste Generator Program moni-
pertaining to owners and operators of solid tors facilities to ensure safe and legal han-
waste facilities in Contra Costa County and dling, storage, and disposal of hazardous ,
the seventeen incorporated cities, except the wastes. Businesses in Contra Costa County
City of Pittsburg. Program activities include that generate hazardous wastes are regulated '
approving solid waste facilities' permits, by this program. HSD conducts compliance
monthly inspections of four landfills,two inspections of these businesses every two
transfer stations, and one compost facility; years. ,
monthly, quarterly, and annual inspections of
fourteen closed, illegal and abandoned sites, Underground Storage Tank Program regu-
three sludge spreading operations, and two lates underground tanks which store hazard-
soil remediation facilities. The Code Enforce- ous materials which have the potential of
ment staff investigates over 1,600 household leaking. These tanks must be registered,per-
trash and garbage complaints annually and mitted,tested, and inspected. The Health Ser
provides follow-up corrections. vices Department(HSD) issues permits and
regulates these facilities to ensure that tanks
The medical waste program protects the health are monitored for leaks to prevent soil and
of the public, health care facility personnel, ground water contamination. In addition,
and landfill personnel from exposure to medi- HSD reviews plans,performs on-site inspec- ,
cal wastes containing potentially communi- tions and issues permits for all new tank in-
cable pathogenic organisms. This program is stallations and tank removals.
20 '
Hazardous Materials Release Response and locations of chemical spills, illegal drug labs,
Inventory Program and Uniform Fire Code pipeline leaks and illegal dumping of hazard-
Article 80.103(b) and(c) cover over 1,200 ous wastes or chemicals. They provide identi-
' businesses in Contra Costa County, including fication of unknown substances, health haz-
major oil refineries and chemical plants. This ardous wastes or chemicals. In addition,they
program, also referred to as the Business Plan initiate the community warning system Bevel-
, Program, requires businesses to submit a plan oped to warn the public in case of toxic spills,
and an inventory of hazardous materials stored fires and other disasters.
on their site with a map of their facility, show-
ing the storage location of hazardous materials Emergency Medical
and emergency equipment. Facilities are in-
spected by Hazardous Materials personnel to Services (EMS)
' ensure compliance with regulations. EMS provides overall direction,planning, and
monitoring for the County's prehospital
Household Hazardous Waste Program pro- Emergency Medical Service system. The EMS
vides ongoing weekend collection events for system consists of fire, ambulance, and related
both recyclable and toxic household waste. services which respond to 9-1-1 medical
These events are provided free to the public. emergencies. A variety of agencies and
In addition,the program,provides information organizations work together to provide per-
about safe alternatives to many products sons who experience medical emergencies
' which contain hazardous materials that may with a timely response delivered in a profes-
leach from the landfill into the water supply. sional and medically appropriate manner.
EMS providers include fire services, ground
' Risk Management and Prevention Program and air ambulance services,public safety
seeks to prevent the accidental release of dispatch centers, law enforcement agencies,
"Acutely Hazardous Materials"(AIM) and to and hospitals,with their medical staffs. Sup-
prepare for public protection in the event of a porting the direct service components are
release. Facilities are required to prepare de- educational and training institutions, citizen
' tailed, step-by-step hazard analyses to identify and medical advisory groups, and various
ways to prevent accidental releases of ARMs other public and voluntary organizations.
and to develop Off-site Consequence Analyses
' for emergency response planning. EMS develops and administers service con-
tracts with emergency ambulance providers to
Spill Prevention, Control and Countermea- assure county-wide emergency ambulance
' sure Program (SPCC) seeks to assure that the coverage provided in accordance with high
218 sites in Contra Costa that have above standards of performance and patient care.
ground storage tanks which store or transport The EMS Agency provides oversight of the
' bulk hazardous materials have filed an SPCC County paramedic program including devel-
plan with the State Water Resource Control opment of treatment protocols for paramedics
Board. to follow while caring for patients in the field,
designation of base hospitals to provide on-
Incident Response Program provides Emer- line medical direction to paramedics, accredi-
gency response staff on-call 24 hours a day to tation for paramedics working in the county,
provide technical assistance and oversight at and coordination of quality assurance activi-
' 21
ties. Planning and monitoring services are '
provided by the EMS Agency for the special-
ized trauma care system developed to assure
that victims of automobile accidents and '
other major trauma receive the highest level
of care.
22 '
1 ❖ Customer Profile
' HSD clients are defined in multiple ways. For some, we are the provider of last
resort,for others the provider of choice, and still others, the only provider for
' certain unique services.
Hospital & Health legislation which govern the use of or access
' Centers to funds. To be eligible for most mental health
services, a child or adolescent must have a
We offer services to all residents of Contra mental health diagnosis from the Diagnostic
' Costa County. The majority of our patients in- and Statistical Manual of Mental Disorders
clude those who are on Medi-Cal,those who (DSM).
are not eligible for any type of federal, state,
or private health plan, and the medically indi- Mental Health Crisis Services- The customer
gent receiving statutorily-required services is generally an individual, family member(s)
under Section 17000 of the Welfare and Insti- or concerned person who is seeking counsel-
' tutions Code of the State of California. We ing or some type of psychiatric intervention,
provide care to many of the members of the including medications for psychiatric symp-
Contra Costa Health Plan, including commer- toms. These clients may have dropped in,
' cial members, County employees, and Medi- been advised by another practitioner to come
Cal eligible persons mandated to choose a in, or on a W&I Code 5150.
health plan under the state's Medi-Cal Man-
aged Care Program. Public Health
Mental Health The core Public Health programs of commu-
nity health assessment, communicable disease
Adult101der Adult Program - Customers are control, and community-based prevention ac-
adults who are functionally disabled and who tivities such as tobacco control, AIDS preven-
are seriously and persistently mentally ill; tion, community and domestic violence pre-
older adults, 60 years and over,who require vention, and chronic disease control and pre-
specialized services due to functional impair- vention serve the entire county population.
ment or significant changes in behaviors re- Public Health Clinic Services target the Medi-
tated to a serious, persistent mental illness; Cal population,the working uninsured, and
and persons who are in severe crisis or are in the indigent population. Other programs focus
danger of suicide, hospitalization or becoming on specialized populations: Family, Maternal,
seriously and persistently mentally ill. Cus- and Child Health on women and children, Se-
' tomers are generally Medi-Cal recipients or nior Nutrition Project on all persons over 65,
Medi-Cal eligible, or have no health care cov- and the Miller Centers on developmentally
erage. Access to service happens through an disabled adults and children.
' individual provider or crisis service and then
through a centralized assessment/authoriza-
tion process. Community Substance
' Abuse Services
Children's Services-Eligibility for services
in the public mental health system is deter- CSAS client data reports show between July
' mined by various pieces of state and federal 1, 1995 and October 31, 1996 there were a to-
23
tal of 2,750 clients who were admitted and Emergency Medical
discharged from non-methadone residential
and outpatient treatment programs; 53.1% Services
were males and 46.9%were females. When EMS serves county residents and all other per- '
methadone clients were excluded from the sons working or temporarily in the county
analysis, drugs of choice most commonly re- - who need the assurance that an emergency
ported by clients were: 46.3%alcohol, fol- medical response system is available should '
lowed by methamphetamine(22.8%), cocaine/ the need arise in the event of day-to-day emer-
crack(18.2%) and heroin(5.1%). gency or disaster. These include: victims of
sudden medical emergencies needing the rapid '
Contra Costa Health Plan response of trained emergency medical pro-
CCHP seeks to serve the special needs of vul- viders to perform emergency treatment and to
nerable populations. It is available to Medi-
provide transportation to the appropriate hos- '
Cal and Medicare recipients, employees of
pital emergency facility;patients subject to
participating private and governmental em- interfacility transfer; as well as emergency re- '
ployers and individual members of the general sponse personnel, advanced life support(ALS)
public. It currently serves over 55,000 people program managers who need program ap-
proval by the EMS Medical Director; EMT-I
living in Contra Costa County. and paramedic training program managers;
and EMS providers and other emergency re-
Environmental Health sponders who rely on a well organized,profes- ,
Our ultimate customers are the general popu- sional LEMS system as one component of the
lation of Contra Costa County who rely on ap- county's overall emergency response system.
propriate inspection and regulatory activities '
to protect their health. More specific custom-
ers include the businesses and individuals
whose activities fall under our jurisdiction. ,
Hazardous Materials ■
Programs - ■
Hazardous Materials Programs serve the entire '
community of Contra Costa County by over-
seeing the handling,processing and storing of
hazardous materials by business. Businesses
and individuals handling hazardous materials
are the more specific customers of our pro-
grams. ,
24 '
•'• custome'r R ofations ips
Each division has a unique blend of relationships with clients as evidenced in
outreach and utilization. Programs vary in their ability to choose clients. Some
programs have very specific eligibility requirements, while others are open to all
1 who come.f or services.
1 Hospital & ority in a patients' needs assessment survey.
A post"Patients' Choice" implementation
Health Centers study conducted in the spring of 1997 showed
' The majority of our patients use our service increased patient satisfaction with access to
because we are the health services of choice. short notice primary care.
' With the advent of the state's mandatory
Medi-Cal Managed Care program in 1997, The division conducts ongoing inpatient satis-
specified Medi-Cal eligibles choosing the faction surveys and annual outpatient satisfac-
Contra Costa Health Plan may identify tion surveys. For inpatient services, staff assist
' Merrithew Memorial Hospital and Health patients in completing a survey that focuses on
Centers as their health care provider. For their care and stay at the hospital. We cur-
indigents enrolled in Basic Adult Care, we are rently receive an average of 400 surveys a
the only available option in the county. Pa- month. Similar patient satisfaction surveys are
tients are informed about our services through conducted in the Ambulatory Care Health
' a variety of formal and informal mechanisms. Centers annually to identify patients' concerns
Formal mechanisms include marketing mate- and to ensure that operational interventions
rials developed by CCHP,notices posted in developed and implemented have been effec-
t other county-wide departments,through So- tive in the eyes of the patients. Inpatient and
cial Services for patients who must choose a outpatient satisfaction surveys are analyzed
health plan under Medi-Cal Managed Care, and incorporated into the division's strategic
relationships with a host of county-wide com- plan and appropriate operational interventions
munity-based organizations, service organiza- are developed and implemented to correct
1 tions, religious organizations and numerous problems identified by our patients.
public guides to services. Informal mecha-
nisms are primarily "word of mouth."Persons Mental Health
enrolled in CCHP are given orientation and
marketing materials which describe the ser- Adult/Older Adult Program. -In the past year,
vices,hours of operation, and points of con- as programs have been redesigned to better
1 tact. meet clients needs, services involving natural
support systems are more available in the
Access to ambulatory care services has been community. Staff are spending more time out
improved tremendously by the Patients' of the office in the community,becoming fa-
Choice Program. Patients' Choice allows pa- miliar with natural support networks, building
tients to make same and next day appoint- stronger relationships with local businesses
ments for primary care upon request. In 1995, and citizens, and becoming a part of commu-
patients identified improved access to short nity organizations that they can influence on
notice appointments as their number one pri- behalf of clients. Client satisfaction, as mea-
'
' 25
sured by standardized satisfaction question- sites throughout the county. In addition, Pub- '
naires,will be administered regularly as soon lic Health Outreach Workers find clients in the
as the State Department of Mental Health communities, including IV-drug users with
makes a decision about the format and over- AIDS,pregnant women and homeless per-
sight of the performance outcomes process. sons. Public Health services are brought to
community settings through Health Care for
Children's Services. -Target population chil- the Homeless, Health on Wheels Mobile '
dren and youth are identified, screened, and . Clinic Van, Home Health Agency, and Public
referred at various"portals of entry"into the Health Nursing. Public Health prevention
system of care. Fees are charged using a state- programs are implemented through partner- '
wide system and are based on ability to pay.A ships with community-based organizations
significant proportion of clients are on Medi- throughout the county. The Homeless
Cal and thus pay nothing for services directly. Ombudsperson evaluates client satisfaction a
For court dependents, entry is through the with homeless services county-wide. The
Emergency Placement System(EPS),which is Public and Environmental Health Advisory
comprised of a number of emergency foster Board and community partnerships provide
group homes. For special education students, feedback on community-based services.
the portal of entry is initially the school, and ,
secondarily the screening unit of the AB3632 Community Substance .
Program. Other seriously emotionally dis- Abuse Services
turbed(SED)youngsters may enter the system ,
via one of the three regional clinics,the Clients are required to pay for treatment ser-
County Psychiatric Emergency Services Unit vices. However, no client is denied services
(E-Ward), or one of the local acute inpatient based on inability to pay. Payment is based on '
units. Administration of a parent satisfaction a sliding fee scale which assesses total house-
survey began in 1997 as part of statewide hold income.
implementation of performance outcomes in '
Children's Mental Health Services in Califor- Most clients gain access to services simply by
applying to community or county operated
nia. '
programs,provided the primary problem is
Mental Health Crisis Services. - Those re- substance abuse. Criminal Justice Treatment
questing services are evaluated and treated or Program clients are referred through programs ,
given recommendations and referrals to the ap- such as DUI or Diversion Programs. Preg-
propriate service for care. Customers gain ac- nant and parenting women are referred by out-
cess to services through look-up telephone di-
reach staff, case managers, and county-wide '
rectories,hotlines, consumer publications, in- provider coalitions with specific goals to im-
formation and referral line through CCHP, ad- Prove perinatal outcomes.
vice nurses and other triage personnel in vari-
ous hospitals and clinics,police departments Services are located regionally throughout the
and other public agencies. We are preparing a county. CSAS staffcoordinatestyith many
community and county agencies,to provide
satisfaction survey to be given to all clients re- '
ceiving crisis services. service to individuals affected by substance
abuse.
Public Health Last year customer satisfaction surveys were '
Public Health clients gam access to Public used in all county operated programs. In addi-
Health services through the clinic and service '
26 '
' tion, CSAS has established three customer sat- vices are provided to all without regard to
isfaction hot lines, one of which is staffed by ability to pay or insurance status. Funding
Advisory Board members. The Customer Ser- through CSA EM-1 is available to EMS sys-
vices Telephone Line in the CSAS administra- tem participants for enhancements in the level
tive office allows clients to anonymously of emergency medical services provided. The
voice complaints and make recommendations EMS Agency relationship with some custom-
for better services. ers is regulatory in nature at times. Hospital
interfacility transfers of emergency patients
Contra Costa Health Plan are monitored. The EMS Medical Director
CCHP regularly surveys its members, and will credentials and provides medical oversight for
conduct a member survey later this year. An- emergency response personnel. The EMS
other measure of members satisfaction is the Agency approves and monitors all advanced
rate of those who disenroll voluntarily. That life support provider programs and prehospital
number is 18% lower in fiscal year 1997 than training programs operating within the county.
the previous year.
The EMS Agency has placed a high priority
As CCHP also considers its providers as cus- on maintaining good customer relations
tomers, it will be conducting provider satisfac- through its day-to-day handling of customer
tion studies of both staff providers and the inquiries/complaints and in annual evaluations
new community provider network in 1998. of the ambulance services. EMS publishes a
' monthly newsletter to enhance communication
Accessibility to specialty care is a major focus with EMS and allied personnel and agencies.
' of attention for both customers and providers
of managed care. CCHP patients are routinely The EMS Agency promotes customer satisfac-
referred to out-of-plan specialists if a Health tion at all levels -the public,the patients and
Center appointment is not available within the the provider personnel and agencies. Feed-
time specified by providers. Additionally, back is received anecdotally through participa-
CCHP has taken steps to enhance its mem- tion in various groups and meetings and from
' bers' access to specialty services within the occasional public inquiries regarding ambu-
County's health centers. lance services. No formal program to measure
customer satisfaction has been undertaken.
' Emergency Medical
Services
' EMS services are available county-wide. The
EMS Agency plays a lead role within EMS
' services coordination among EMS providers
and other emergency responders. Property
owners pay an annual assessment to CSA
' EM-1 to maintain availability of enhanced
EMS services. Victims of sudden medical
emergencies pay for emergency ambulance
service; Medi-Cal, MediCare, and private in-
surance cover the majority of patients. Ser-
27
' � 1
Per ormance Indicators
The approach to performance indicators is changing. Most used to focus on the
program/system/institutional measures of inputs — how many visits provided,
shots given, permits approved. Some of those measures remain relevant, but we
are moving toward identifying the outputs, or outcomes of the activities,focusing
on the effects on patients/clients/customers. This process is complex. Each Divi-
sion, especially those with multiple programs, is examining what should be mea-
sured. In addition, many programs are directed by regulatory agencies which
specified the desired measures. For specific comparisons of data in FY 1995-96
' and FY 1996-97, see Attachment C
Hospital & Mental Health
' Health Centers Adult/Older Adult Services-A Performance
This division has developed multiple indica- Outcome Study was initiated in 1994 and re-
tors and outcomes to monitor and improve sults were analyzed recently by the Mental
quality and patient satisfaction. Some are de- Health Commission. Eleven of the perfor-
mance outcome measures were used as key
termined by regulatory agencies, such as the indicators. In Contra Costa County, only two
State Department of Health Services Licens- of the six domains showed results signifi-
' cantly different from the state-wide average:
ing Division, and the Joint Commission of Accreditation of Healthcare Organizations.
Examples include: living situation was below the average and en-
gaging in productive daily activity was above.
• Average length of stay In addition,we will be looking at performance
• Emergency Department utilization
• Patient satisfactionIn
such as reducing state hospital bed
• Cost per patient per day days,RvID beds, acute hospital beds, improve-
Number of Ambulatory Care Visits per ment in living situation, educational activities,
'
month by site work status, and decreases in alcohol and/or
• Medical and nursing staff quality assur- drug use.
ance' • monitoring
Children's Service Program -Legislation re-
QA monitoring by ancillary Ydepartments quires that all counties report data on perfor-
mance measures adopted by the California
29
Mental Health Planning Council of the State eights of the data collected show that ,
Department of Mental Health.A multi- 16.6% of clients complete their treatment
method approach has been adopted to meet plans. Of those clients who exit treatment
these requirements. The outcomes to be mea- early, less than half(42.1%) leave treatment ,
sured fall into two general categories: 1-sys- with"unsatisfactory progress", 9.5% leave
tem level measures and outcomes, and 2-con- with"satisfactory progress"and 20.4%were
sumer level measures and outcomes. Many transferred to other treatment providers. '
standardized instruments are used to measure,
assess and suggest treatment goals. Contra Costa Health Plan
CCHP regularly monitors utilization and en-
Public Health rollment trends for each of its major groups
Public Health evaluates performance by look- and reports results on a monthly basis to the '
ing at community health indicators such as in- Managed Care Commission.
fant mortality, utilization of early prenatal
care, and tuberculosis rates. Clinical Services Environmental Health ,
are evaluated by process measures including Annual Division Program Plans identify the
number of clients served, cost per unit service, total workload of all programs and set activi-
and staff productivity measures. The Public ties for each program. Individual staff mem-
Health Data and Evaluation Unit has been bers complete Annual Performance Evalua-
charged with developing more targeted out- tions that include the identification of activi- '
come evaluations of Public Health programs, ties they plan on accomplishing during the
especially Family, Maternal, and Child Health
pYear. Standards for the solid waste, medical
programs and the county's programs focusing '
on the homeless. waste, small water system and detention facili-
ties are established by the appropriate state
agency and ongoing state Local Enforcement
Community Substance Agency(LEA)certification is dependent on '
Abuse Services meeting the state standards. In the retail food
CSAS developed thirteen major indicators to and consumer protection programs, standards '
monitor the effectiveness of the Division's of service are based on state guidelines and lo-
prevention efforts. The CSAS focused most cal ordinances.
of its prevention work on alcohol-related ac- '
Hazardous Materials
tivities and policy initiatives, and the perfor-
mance indicators reflect these efforts. During Programs
FY 1997-98, CSAS providers and programs The Division is responsible for implementing
are required to collect process and outcome regulatory oversight of hazardous materials
indicators. '
under various State and County laws. Toward
this end inspections, training, investigations,
Treatment outcomes measure length of time reporting, and enforcement activities are
in treatment as well as discharge status when a tracked and documented. While the Division's '
client leaves treatment. The majority of(53.9/ogoal is to protect the health of the community
CSAS
clients were lri), compared to 46.1 outpatient/o tient treatment of clients in resi- safe,performance is measured by the number '
of incidents impacting or threatening commu-
nity health and safety.
i
30
1 A statistical study, recently concluded for cal-
endar years 1989 through 1996, shows that for
this period of time there were an average of
five (5)major incidents per year with an an-
nual range of between 2 and 9 incidents.
There has been no statistical significance in
the increase or decrease in the number of inci-
dents affecting community health and safety.
1
Emergency Medical
Services
Emergency Medical Services statistics are
1 monitored in five areas: ambulance services
and air ambulance services (primarily patient
stabilization and transport systems);trauma
I services and first responder defibrillation ser-
vices (triage, "saves" and trauma services);
and inter-facility patient transfer review ser-
vices (general oversight of patient transport).
Utilization statistics and trends are compiled
for each area on a regular basis, including the
number of units dispatched, average response
times, number of patients transported and the
number and type of"saves".
I
i
i
1
1
i
1
31
♦.♦ Accompis meats
Hospital & D 1
e a oped new format for the requ�ed
Health Centers Safety/Infection Control Review Training
Continued success and improvement of that significantly reduces training costs.
• "Patients' Choice Program." Same/next
1 day appointment capacity increased from Mental Health
11% of family practice appointments to Children's Services
' 68%; reduced the percentage of patients Implementation of programs funded by
who do not show up for their appoint- AB3015,the California System of Care
ments; reduced Emergency Department Contract to reduce group home placements
Utilization. in the county. These programs include a
collaborative effort with the Probation De-
e The"Patients' Choice Program"was hon- partment to provide day treatment, residen-
ored with two awards -the 1996 California tial, and educational components to youth.
Association of Public Hospitals' Manage- In addition,the Intensive, Intermittent In-
ment Excellence Award and the 1997 Na- tervention program(I'P)works with the So-
tional Association of Public Hospitals' cial Services Department.
Safety Net Award for Innovation.
• Expansion of children's mental health ser-
' • Hospital and Health Centers Lab received vices through receipt of EPSDT(Medi-
full accreditation from the Joint Commis- Cal)funding.
sion on Accreditation for Health Care Or-
ganizations. Adult Services
• Adult Services put out a Request for Pro-
t • Full accreditation of cancer program. posals for 54 new augmented board and
care beds. Twenty-four of these beds will
• Full accreditation for Family Practice become available in the next few weeks.
' Residency Training Program. Consumers are ready to be discharged
from MD placements into these beds.
• Implementation of a successful Psychiatric This will represent a savings of approxi-
Outpatient Day Treatment Program that mately $800,000 in residential costs.
expands the continuum of care for psychi-
atric services and focuses on teaching pa- Developed a collaborative effort with the
tients skills they need to live in the com- Community Substance Abuse Services Di-
munity vision,to apply for a federally-funded
grant which was received. This grant
• Implementation of computerized Order fuding will to provide intensive case man-
Entry system and Radiology Reporting agement services to consumers who have
through the MediTech system, improving concurrent mental health and substance
efficiency and access to necessary medical abuse diagnoses in West County.
information by staff via the computer.
33
i
• A Vocational Services Coordinator posi- Five free sealant clinics were held county-
tion was fully implemented in June 1997. wide which provided 1,246 free sealants to
The cooperative contract with the Depart- 270 children at an in-kind value of over
ment of Rehabilitation(DR)was reestab- $50,000.
lished for 1997-98. This contract provides ,
two FTE counselors County-wide, evenly A portable dental unit was donated by-the
divided among the three regional DR of- State Oral Health Needs Committee and
fices. (Each office has a designated DR/ =the Mt. Diablo Dental Hygiene Society.
MH contract counselor.) The contract This unit will be used to provide preven-
provides case service dollars for supported tive dental services to children at school '
employment,job development, placement sites.
and job coaching, vocational training, and
supported education. Services are sup- Women Infants& Children '
plied by community agencies as vendors. (WIC) Program
• Received awards of recognition from the
Public Health California WIC Association in the catego-
ries of. "Monumental Program Growth",
Senior Nutrition and"Innovative Outreach".
Added one Home Delivered Meals (HDM)
route in Pleasant Hill/Concord area.Expanded Received multiple state authorized
scope of HDM provider contract to include caseload increases throughout the year tak-
AIDS patients. Raised $40,000 in public con- thg the caseload from 13,400 to 16,500 at
tributions to purchase meals for homebound year end, a 23% increase, based on dem-
elders. onstrated successful outreach and expan-
sion performance after each incremental
George Miller Centers-East& West increase during the year.
Implemented an after school program which is
expected to be at full enrollment by December Implemented on-line communication with
1997. The centers provide social recreation the state WIC computer system in Decem-
and day care programs serving those with spe- ber, inputting 10,000 client family records. '
cial needs between the ages of 11 and 22 System includes performing client certifi-
years. Home infant services have also cations and appointment scheduling on
doubled from last year. line.
Dental Program Family,Maternal, and Child Health
• Since opening in April 1996, over 200 '
children have received dental services at perinatal Services Program
Parkside elementary school's dental clinic, The Perinatal Services Program has
a partnership with the Healthy Start Pro- worked closely with both Managed Care
gram, Pittsburg Unified School District, Plans in development of work plans to
and the Contra Costa County Dental Asso- guide the daily implementation of compre-
ciation. Volunteers continue to support hensive perinatal services. A collaborative
this clinic. A new Healthy Start dental data project,Managed Care Perinatal Out-
clinic is scheduled to open in 1998 at comes Project, is close to the piloting
Peres elementary school in Richmond. stage.
34
• Continued to focus efforts on priority ar- Increased by 10%the number of children
eas relative to improving perinatal out- screened for wellness care. This increase
comes in Contra Costa County such as do- represents a total of 4,000 children above
1 mestic violence,tobacco cessation, food the number reported in FY 96-97.
access, and lactation support.
Public Health Laboratory
• A new program,Perinatal Outreach En- • Started performing TB tests for Martinez
hancement,was funded. This program Veteran's Clinic and Mt. Diablo Hospital.
focuses on reaching hard-to-reach popula-
tions in order to increase access to early • Implemented more sensitive molecular bi-
and continuous perinatal care. This pro- ology-based testing for STD's, MTB, and
gram also provides a variety of activities HIV.
to increase education and access.to cultur-
ally appropriate tobacco cessation services • Implemented oral fluid testing for HN
' including free acupuncture services as an outreach programs.
adjunct to group counseling and case
management services. • Implemented Hepatitis C antibody screen-
mg
California Children's Services (CCS)
• Developed and implemented procedures Public Health Clinic Services
' for effective case management and utiliza- • Received funding from a state grant to
tion review activities with the County's participate in collaborative pregnancy pre-
two Medi-Cal Managed Care Plans. vention efforts in West County.
• Developed and implemented on-site • Developed a Teen Health Corps at Rich-
Medi-Cal utilization review at Children's mond High School to involve young
Hospital Oakland. people in health-related activities and
steer them toward health careers.
• Increasing media and community aware-
ness of the CCS program and increasing Worked collaboratively with Richmond
on-site utilization review activities at High School's Health Academy and Rich-
other hospitals. mond Health Center's Pegasus Project to
develop a health career mentoring pro-
Child Health and Disability gram for high achieving students.
' Prevention Program (CHDP)
• Implemented a second-hand smoke pre- Worked with the County Office of Educa-
vention project with families where chil- tion to enhance the curriculum for classes
' dren are exposed, by history,to tobacco at Juvenile Hall.
smoke. This project targets children birth
' to age 5. Expanded number of Immunization Clin-
ics and clinic sites with more comprehen-
• Implemented an anemia prevention and sive accessibility to the community. In ad-
high iron intake project among children dition,held weekly employee immuniza-
with blood values below those recom- tion clinics.
mended by the Academy of Pediatrics.
' 35
• Continued weekly Breast Cancer Screen- nated and that parents know which immu-
ing Clinics in East, Central, and West nizations their children need and where
County. Initiated Breast Cancer Screening and when to go to get them.
outreach and follow-up on identified prob-
lems. Mobile Clinic Services provides a mobile
clinic for West county residents four days a
• Worked with Mt. Diablo School District, week. Services include: limited primary
to apply for and receive a Healthy Start care, STD services,Family Planning,111V
grant which will expand health programs testing and counseling, TB testing and im-
for the Monument Blvd. corridor in Con- munizations. This clinic is provided
cord. through a cooperative agreement with Kai-
ser and Brookside Hospital. A new mobile '
• Bay Point Community Wellness Center clinic van will be purchased with funds
opened as a combined center for Well provided by Chevron.
Child and Pediatrics under Public Health ,
as well as primary care under Hospital and Home Health Agency
Health Centers. Increased nursing productivity by 11% and
increased patient visits by 13%, while re- '
• Increased surveillance of identified health ducing annual program costs (i.e., County
problems from PAP reports. subsidy)by over 82% from FY 95-96.
• Established& implemented training for Community Wellness '
low income youth on health related issues. & Prevention Program
Healthy Neighborhoods Project
• Developed a Quality Assurance Program In its second year,the Project mobilized
for Public Health Clinic Services. communities in East and West County to
embrace the Healthy Neighborhoods con-
Acute Communicable Diseases cept and gain funding for a Lead-Safe pro-
Immunization Registry implemented a gram which will be implemented next
software program which registers immuni- year.
zations received for children ages 0-2 and
eventually 0-21, at all Public Health Clin- Tobacco Prevention Project '
ics in the county and at Pittsburg, Bay Launched the Youth Mobilization Project,
Point and Brentwood Health Centers. a youth-driven project aimed at reducing
Currently the immunization records of tobacco advertising and youth access to to-
over 60,000 people have been entered into bacco. Released Tobacco-Free Youth
the registry. This system will ultimately policy paper to provide basis for model
include data for all community providers Ordinance. '
under CCHP, as well as private providers
who give immunizations to children and Lead Poisoning Prevention Project
elect to enroll in the system. Provided direct services to over 430 chil- '
dren and their families. Assisted the City
• Immunization Outreach Cooperative of Richmond in applying for HUD funding
Project developed to insure that immuni- to ameliorate causes of lead poisoning in '
nation services for children are coordi- homes occupied by children.
36 ,
Bicycle Head Injury Prevention Project borhoods throughout the county.
Distributed additional 2,000 helmets to
Pittsburg children and developed survey Homeless Programs
tool to track distributed helmets and evalu- Outreach to homeless individuals,police
ate the educational component of the inter- departments, cities, and Caltrans has been
vention. developed and increased due to the pres-
ence of the Homeless Ombudsperson/Liai-
Breast Cancer Partnership son.
Provided community-based outreach to
women and families through eleven mini- Shelter Plus Care I and lI have met the
grants to agencies serving women of color. HUD obligations for housing units served.
Increased the Provider Network to 32
health care providers to institutionalize Secured Shelter Plus Care III funding to
breast health care. serve HIV/AIDS individuals.
' Violence Prevention Project The Five Year Continuum of Care Home-
0 Implemented the fifth annual "Increase less Plan was developed and approved by
the Peace"Month,with a broad range of the Board of Supervisors.
community partners and local corpora-
tions. The 1996 HUD Homeless Assistance Pro-
gram received approximately$3.1 million
• Hired a nationally recognized community dollars in funding, for seven new programs
organizer to launch the Violence Preven- to provide homeless and housing services
ttion Action Plan,which was endorsed by throughout the County.
County voters.
• The development of a new emergency
• Developed"Tools for Ending Relationship shelter program structure that allows for an
Violence"for providers working with emergency shelter within the 90 day case
pregnant and parenting teens. managed shelter program. This provides
the opportunity for people to come in off
Hunger,Nutrition & the streets for a 30 day respite period.
' Physical Activity Projects
• Developed three culturally sensitive, low- • The Homeless Hotline is operated 24
fat diet and exercise videos which are be- hours a day, seven days a week, year round
ing marketed nationwide and have been so that homeless individuals who call can
shown on Contra Costa Cable TV. always speak with a person. The program
has been stabilized and has increased
• Launched a scholarship fund for low-in- credibility in the public eye.
come adults who want to participate in ex-
ercise classes;trained seven community Community Substance
residents to lead aerobic dance and walk-
ing groups. Abuse SerW ces
' Established an internal management-
Completed data collection for food re- planning group to initiate the development
source maps for four low income neigh- of CSAS System of Care, an integrated
' 37
continuum of care that would improve and According to the California Medical
increase access to services, accountability, Association, CCHP has the second lowest
client and system performance outcomes. administrative costs of the 12 HMOs
operating in Contra Costa County. CCHP '
• Hired consultants to provide technical spends 92% of its revenue on medical care
assistance and training in Quality Manage- and only 8% on administration. Within
ment and Learning Organization prin- the State of California, CCHP is the fourth
ciples, concepts and practices. lowest of 47 HMOs.
• Presented a framework for the CSAS Environmental Health
System of Care Initiative to the Board of The mobile food preparation unit(Vehicle
Supervisors. inspection)program received increased
• planning
Created a lannin process to ensure attention, and many of the units that were ,
operating without permits or inspections
inclusion of client and consumer perspec- were brought into compliance. ,
tives, and providers from mental health,
public health,hospitals and clinics, in the The California Integrated Waste Manage-
development of CSAS System of Care. •
ment Board reviewed the annual documen-
•
Effective January 1, 1998,the CSAS will tation required from the Local Enforce-
implement an integrated system of care to ment Agency(LEA), and voted to recertify
deliver prevention and addiction treatment the LEA. '
services to county residents. The Medical Waste Management unit of
• the Department of Health Services (DHS)
Contra Costa Health Plan conducted an on-site program review and
• Between July 1996 and June 1997, enroll- granted program recertification. Permis-
ment in CCHP grew from 24,706 to sion was granted to DHS to use some of
55,323 members. The growth reflects the Medical Waste program policies and
increases in the AFDC Medi-Cal mem- procedures for models to other county
bers, who are now 78% of CCHP's total LEAs.
enrollment. This increase is a direct result
of the implementation of the Two-Plan The Office of Drinking Water, Department '
Model for Medi-Cal Managed Care in of Health Services conducted an on-site
Contra Costa County. program review of the Small Water Sys-
tems Program and granted recertification r
• CCHP expanded its provider network to to the LEA.
accommodate the increased membership.
It established as one of its programs the Hazardous Materials
CCHP's Health Partnership for Medi-Cal. The HazMat Program recently became
This partnership consists of our Hospital •
&Health Centers,Kaiser and community the Certified Uniform Program Agency '
physicians and hospitals including Planned (C'UPA)for all of Contra Costa County.
The Division will be directing efforts
Parenthood. toward fulfilling the legal and regulatory ,
requirements of these programs.
38 ,
' Emergency Medical Funding was obtained from the State to
Services support the role of the Contra Costa
County Health Officer as the Regional
• A comprehensive new Emergency Medical Disaster Medical/Health Coordinator for
Care Committee"standing committee" the Northern California Coastal Region.
,structure was developed and implemented . Emphasis was on setting up procedures for
' to begin an ongoing evaluation of EMS facilitating disaster medical response
system performance and to make recom- within the region.
' mendations for future action. This evalua-
tion will be made based on standards Oversight and medical direction for the
identified in the County EMS System Plan EMS first responder defibrillation program
approved by the Board of Supervisors in was provided. Under this program, all
1995. EMS areas being addressed include firefighters county-wide are trained and
system organization/management, staffing/ equipped to use automatic defibrillators to
training, communications, response/ provide electric shock to heart attack
transportation, facilities/critical care, data victims. During 1996, 461 patients in
collection/system evaluation, disaster cardiac arrest were evaluated for treat-
medical response and public information/ ment, 145 treated, 35 saved for hospital
education. admission and 17 discharged from the
'
• The EMS Agency maintains the"1-800-
hospital.
GIVE-CPR"telephone number to make In addition to funding for the Regional
available information regarding citizen Disaster Medical/Health Coordinator
' CPR training to the public. Pacific Bell project, a third year of funding from the
has included this number in telephone State EMSA was obtained for an evalua-
books for all regions of the County. tion of poison control center alternatives.
• Under the direction of the Board of Super- Ambulance services under contract re-
visors, initial work has been completed sponded to 46,980 emergency requests in
towards implementation of a pilot fire 1996. Of these, 34,009 resulted in patient
engine-based paramedic program in the transport to a hospital emergency depart-
Contra Costa County Fire Protection ment.
District which could make advanced life
support care available to patients prior to All injured patients were evaluated using
' the arrival of ambulance paramedics. A field trauma triage criteria established by
one year engine-based first responder the EMS Agency. Of those, 852 were
program in the Bethel Island Fire Protec- transported under County trauma protocols
tion District was begun with medical to a trauma center,usually the County-
oversight provided by the EMS Agency. designated John Muir Trauma Center.
' • Standards were adopted for"Enhanced
First Responder Programs",which will
' assist first responder agencies in imple-
menting and evaluating their EMS pro-
grams.
' 39
•'• c6affenges
The challenges to be faced by Contra Costa Health Services in the coming year
are both internal and external. The continuing growth of managed care requires
us to become more adept at managing risk, increasing quality and patient satis-
faction, and matching costs to available resources. The advent of welfare reform
brings some added responsibilities to Health Services, potentially reduces Health
Services revenues, and creates new financial pressures on the overall County
' budget, as people lose benefits to which they were entitled previously.
The competitive health care environment re- age our fiscal and human resources to main-
quires us to be able to move quickly to hire or tain the appropriate balance between our twin
reorganize staff, to purchase equipment, and missions of comprehensive health care deliv-
to reallocate'fimds among budget categories. ery and community health promotion. We
We must also continue and expand, when nec- must increase the understanding within our
essary, our key partnerships with the private own workforce of how our various programs
' sector in order to maintain or increase our enhance each other, of which programs need
competitiveness. We must rely on leadership to become more coordinated with each other,
from our Board of Supervisors to remain ac- and of which programs need to provide better
tively involved in understanding the issues, customer service to each other. Finally,to be
exploring alternative funding possibilities, and successful,we must provide employees with
developing the necessary consensus to address the tools to negotiate successfully the changes
the challenges to come. This leadership be- we will be undergoing.
comes all the more critical if more and more
uninsured people with limited ability to pay . Our internal customer satisfaction efforts must
' turn to us for their health care. be matched by greater external satisfaction
with our programs. Not only must we in-
We face a number of inter-related internal crease patient satisfaction with all of our ser-
challenges. The pressures on our public vices, but we must also increase positive pub-
health care delivery system cannot be allowed lic recognition of the regulatory, health im-
to overwhelm our continuing need to provement and health protection programs
strengthen our community health improve- which we operate.
ment and protection programs. We must man-
'
' 41
•'• New Directions
• 1
In order to meet our challenges, we will continue to develop new strategies in the '
following areas:
Medi-Cal Managed Care
Medi-Cal managed care in Contra Costa Health Services has been forging new program '
County was structured by the State to be a linkages with the Social Service Department
two-plan model: the local initiative(CCHP) to address community concerns about
and a commercial health plan. The local ini- CalWORKS and to build the new programs to
tiative captured 94% of all members in Contra identify, assess and treat mental health and
Costa County, with Foundation Health Plan, substance abuse issues in the CalWORKS
the commercial plan, enrolling fewer than population, and to assist parents in obtaining
4,000 members. Currently, discussions are the necessary immunizations for their chil-
underway between the State, Foundation and dren. These efforts will continue in 1998.
CCHP to consider implementing another
model in Contra Costa County. In addition,we continue to be concerned about
the possible"delinking" of Medi-Cal eligibil- ,
Such a plan would be a variant of the County ity determination from the CalWORKS pro-
Organized Health System (COHS) and would gram. We will be monitoring State and Fed-
contract with the State to care for all Medi-Cal eral program regulations for further develop-
eligibles. Under this plan, Foundation could ments.
become one of the subcontractors under the Mental Health '
County umbrella. This model requires federal
legislation which was introduced in November Managed Care
but will not be acted upon until the 1998 ses- As a result of the consolidation of two funding ,
sion. During the coming year, this effort to sources (Short-Doyle and Fee-For-Service
develop a County Organized Health System Medi-Cal funds, administered by the State De- ,
will be a major priority for CCHP as we weigh partments of Mental Health and Health Ser-
its risks and benefits in our effort to strengthen vices,respectively), our Mental Health Divi-
the public health care system. sion will operate as a Managed Care Plan. '
Mental Health will be responsible for the ad-
Welfare Reform ministration and provision of all specialty
CalWORKS, California's version of welfare mental health services to Contra Costa's
reform,will require Health Services to de- Medi-Cal recipients. The date for implemen-
velop new programs. As part of the legisla- tation of Mental Health Managed Care is April
tion, recipients of CalWORKS are required to 1998.
participate in designated work activities.
Work activities have been expanded to include Mental Health managed care may significantly
substance abuse and mental health services. impact the County's fiscal risk as services will '
In addition, documentation of child immuniza- be expanded to a broader target population..
tions must be provided by parents. Tasks for implementation include the develop-
42
ment of a contracted provider network and ad- tion and addiction treatment services to resi-
tministrative and technical support mecha- dents throughout the County. This system is
nisms needed to manage it. designed to increase access to services, to in-
crease accountability and to improve client
Social Health and system performance outcomes. The three
Maintenance keys to its success will be effective automa-
tion, management of access and case manage-
Organization (SHMO) ment of clients with multiple co-occurring
The Social HMO is planned for implementa- problems. This system has been designed in
tion late in 1997. It combines preventive, concert with County staff and contract agen-
acute and extended care for seniors into an in- cies. We expect it will lead to more effective
tegrated system. This innovative approach to use of our scarce substance abuse service re-
helping the elderly will assist them in main- sources.
taining their independence as long as possible
and reduce the need for hospitalization and New Models for
' nursing home care. It is a risk-based financing CommunityHealth
model in contrast to the current cost contract
model for Medicare services. Under our cur- Improvement
' rent cost contract, CCHP is reimbursed at cost Our Office for Service Integration will con-
for Medicare services,members pay premiums tinue implementation of model programs in
' for additional benefits, and Medicare copays east and west county to bring together primary
and deductibles. Under the Social HMO, care and community health improvement ac-
CCHP will receive a capitated rate for each tivities to address long-standing health con-
member based on a health status risk adjust- cerns in specific geographic areas. In west
ment methodology (Le.,how ill the person is). county the effort combines the resources of
Because the Social HMO is not a cost reim- the Center for Health, Partners for Health and
bursed program,the challenge will be to main- Public Health's Healthy Neighborhoods
tain strict cost controls and to manage utiliza- Project. In east county the Bay Point Commu-
tion to avoid the need for expensive nursing nity Wellness Center has been operating for
' home care or hospitalizations. one year as a site integrating Public Health,
Ambulatory Care, Mental Health and school
By 1999, it is expected that the Social HMO district and community resources. The open-
could have as many as 1,000 members. The ing of the Center for Health in late 1998 pro-
program is important to Contra Costa County vides the opportunity for restructuring pro-
on several levels. It expands and improves the grams and resources in order to achieve com-
level of care available to our frail elderly munity health improvement outcomes. The
population. It also strengthens our health care hiring of a coordinator for the Bay Point Com-
delivery system by offering a new model of munity Wellness Center will allow for in-
service which in this day of intense competi- creased outreach and partnership with commu-
tion is necessary to maintain market share and pity residents.
' financial viability.
Delivery System
Substance Abuse Improvements
rSystem of Care We have set two goals for our comprehensive
Effective January 1998 we will implement an health care delivery system: to increase patient
' integrated system of care to provide preven-
t43
satisfaction and to decrease costs per unit of Brand Name Recognition '
service. Two subgoals supplement these
overarching goals. They are to increase staff �CuStOmer Satisfaction
satisfaction and to increase continuity of care. Brand name recognition is a common market-
It is apparent that in order to improve our ing device in the private sector. It has become
health care delivery system,we must better an important method for health care providers
-coordinate service delivery across our divi- to distinguish their services from their com-
sions. Our public health, mental health, sub- petitors'. The competitive challenges facing
stance abuse, and medical care programs pro- -our service delivery system warrant our devel-
vide a wide range of services and share many oping a distinguishing name and"trademark" ,
of the same clients. However,when a client logo in order to highlight our positive pres-
falls between programs or receives similar ser- ence in the market. A single strong identity
vices from several divisions,we have de- for the many different programs which we op-
creased our efficiency, decreased client satis- erate will also reinforce our internal work of
faction and increased our costs. integrating services.
This ear,we formed the Brand Name Reco - ,
In order to improve the ways client care is co- Y � g
ordinated among the five divisions—Contra nition Task Force to help Health Services in- ,
Costa Regional Medical Center/Contra Costa crease positive public recognition of all that
Health Centers, CCHP, Mental Health, Public we do. The Task Force has developed a single
Health and Community Substance Abuse Ser- logo for use by all Health Services programs
vices—we have initiated the Coordinated and revamped Division names and letterheads
Case Management Task Force. The Task in order to promote more internal and external
Force is defining the changes necessary to in- recognition of how all of our programs are '
sure that services across divisions are pro- part of one Department. Pending approval of
vided efficiently and effectively to meet client these brand name recognition tools for Health
needs in a comprehensive manner and to in- Services by the Board of Supervisors,the Task '
crease satisfaction for clients and stag. Force will implement internal culture change
activities during 1998 which will allow each
California Healthy Division to define their internal customers and
implement changes to increase internal coordi-
Families Program nation and responsiveness. These activities
California's new program for uninsured chil- will also identify Division-specific goals and '
dren is being designed by the State during the implementation plans for increasing external
next several months. We expect that CCHP customer satisfaction and positive public
will become one of several plan choices avail- recognition of program activities and services. ,
able in Contra Costa. We serve many unin-
sured children now through our Hospital and ,
Health Centers, as well as our Public Health
Well Child and Immunization services. We
will be identifying and implementing the nec-
essary program changes in order to insure our
competitiveness once parents are informed of
their choices.
44
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ATTACHMENT A
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ATTACHMENT C
PERFORMANCE INDICATORS
' The following data contains comparison data for FY 1995-96 and FY 1996-97.
CONTRA COSTA REGIONAL MEDICAL CENTER
AVERAGE DAILY CENSUS
Fiscal Year 1995-96 Fiscal Year 1996-97
126 118
AVERAGE LENGTH OF STAY(DAY
Fiscal Year 1995-96 Fiscal Year 1996-97
Medical Units 4.28 4.08
Psychiatric Units 15.97 13.24
CONTRA COSTA HEALTH CENTERS
AVERAGE MONTHLY OUTPATIENT VISITS
' CENTRAL COUNTY Fiscal Year 1995-96 Fiscal Year 1996-97
' Martinez Specialty Clinics 3,610 3,549
Martinez Family Practice Clinic 3,570 3,929
Martinez Dental Clinic 309 312
Martinez Healthy Start 194 153
Concord Older Adults 447 443
Concord Health Center 806 940
Subtotal Central County Visits 8,936 9,326
EAST COUNTY Fiscal Year 1995-96 Fiscal Year 1996-97
Bay Point Wellness Center n/a 168
Pittsburg Health Center 4,046 4,376
' Pittsburg Dental Clinic 313 316
Pittsburg Healthy Start 162 163
Antioch Health Center n/a 279
Brentwood Health Center 834 828
' East County Older Adults Clinic 190 167
x W
„Subtotal East County V�s�ts, v 5;545.: 6,297
WEST COUNTY Fiscal Year 1995-96 Fiscal Year 1996-97 '
Richmond Health Center 4,786 5,223
Richmond Dental Clinic 256 276 ,
Richmond Healthy Start 142 194
West County Older Adult 235 238
ubtotal:WestCounty Visits 5 419 5 931
EMERGENCY Fiscal Year 1995-96 Fiscal Year 1996-97
DEPARTMENT AVERAGE
VISITS PER MONTH
3,339 2,870
AVERAGE VISITS PER Fiscal Year 19.95-96 Fiscal Year 1996-97
MO. BYPAYMT SOURCE
(All Health Centers) ,
Medicare 2,218 2,318
Medi-Cal 7,016 7,580 '
Basic Adult Care 4,629 4,277 '
HMO 5,811 6,351
Private Pay 1,871 2,370 '
Private Insurance 421 434
All Other 1,259 1,011
} O
Total 23,22524,341
ii
1 '
r
' CONTRA COSTA HEALTH PLAN
ENROLLMENT BYPAYOR May 1996 May 1997
' AFDC 10,383 40,787
Cross Over(Medi-Cal &Medicare) 469 481
' Other Medi-Cal 1,190 2,946
SeniorHealth 522 479
' Commercial Members 6,299 6,405
' AIM/HIPC/MRIVIIB 74 61
Basic Adult Care 5,539 4,887
Rk
Health Plan Total 24,476.„ 56,046'
1
r CONTRA COSTA COMMUNITY SUBSTANCE ABUSE SERVICES
TYPE OF SERVICE' Fiscal Year 1995-96 Fiscal Year 1996-97
' Outpatient Treatment 1,295 1,189
Outpatient Intensive 213 191
Day Treatment
Residential Detoxification— 19 19
rNon-hospital
Residential Treatment 5,614 5,089
30 days or less
' Residential Treatment 11 1
30 days or more
' Methadone Detoxification 3,238 2,516
Methadone Maintenance 297 240
Primary Prevention 118,071 120,897
' Secondary Prevention 2,233 1,591
Driving Under 3,446 1,825
' Influence Program
Total 136,432
„
13 58;
r
iii
CONTRA COSTA HEALTH PLAN
ENROLLMENT BYPAYOR May 1996 May 1997 '
AFDC 10,383 40,787
Cross Over(Medi-Cal & Medicare) 469 481 '
Other Medi-Cal 1,190 2,946
SeniorHealth 522 479 '
Commercial Members 6,299 6,405 ,
AIM/HlPC/MRIVIIB 74 61
Basic Adult Care 5,539 4,887 ,
Health Plan Total 24,476 56,046'`
r_ .. ..
CONTRA COSTA COMMUNITY SUBSTANCE ABUSE SERVICES
TYPE OF SERVICE' Fiscal Year 1995-96 Fiscal Year 1996-97 '
Outpatient Treatment 1,295 1,189
Outpatient Intensive 213 191 ,
Day Treatment
Residential Detoxification— 19 19 '
Non-hospital
Residential Treatment 5,614 5,089 ,
30 days or less
Residential Treatment 11 1 ,
30 days or more
Methadone Detoxification 3,238 2,516 '
Methadone Maintenance 297 240
Primary Prevention 118,071 120,897 '
Secondary Prevention 2,233 1,591
Driving Under 3,446 1,825
Influence Program
Total 136,432 133;558
1 Individuals served
iii ,
1
1
CONTRA COSTA MENTAL HEALTH
AVERAGE MONTHLY OUTPATIENT VISITS
Fiscal Year 1995-96 Fiscal Year 1996-97
MENTAL HEALTH
CLINICS
Central County 3,643 4,098
rEast County 1,157 1,587
' West County 2,994 3,325
qK
Total 7,794 9,010.
1
Fiscal Year 1995-96 Fiscal Year 1996-97
' SPECL4LTY CLINIC
E Ward- Crisis 1,833 1,901
' Specialty Children's Clinic 1,078 997
' Day Treatment 3,939 3,945
Contracted Program 990 1,616
Total '_ t '� 7,8408,459'
1 r
Fiscal Year 1995-96 Fiscal Year 1996-97
BY PAYOR
' Medicare 1,352 1,418
Medi-Cal 7,683 9,246
' Basic Adult Care 510 432
' HMO 137 187
Private Pay 208 197
' Private Insurance 448 530
Other 2,578 2,755
Y
Total Average Number of Visrts v, 12;916 14,765
r
riv
CONTRA COSTA PUBLIC HEALTH
Home Health Agency '
Fiscal Year 1995-96 Fiscal Year 1996-97
NURSING PRODUCTIVITY 5.06 5.61 '
Average#of Visits per Day
per Nurse
Fiscal Year 1995-96 Fiscal Year 1996-97
AVERAGE NUMBER OF 2,491 2,793 '
CONTACTS PER MONTH
(all HHA staff '
Senior Nutrition Program
MEALS SERVED Fiscal Year 1995-96 Fiscal Year 1996-97
Congregate Meals 14,215 14,374 '
Home Delivered 12,594 13,128
Home Delivered—AIDS 303 306 '
Guardian Care 687 1,017 '
(Developmentally Disabled)
;Total Meals Served „ 27;799 k 28,825
Public Health Clinic Services
AVERAGE CLIENT Fiscal Year 1995-96 Fiscal Year 1996-97 '
ENCOUNTERS
PER MONTH
Child Health Screening 237 258 '
Teenage Program(TAP) 142 153
Refugee Program 49 24 '
Family Planning/STD 471 491
Total Encounters N ,s 898
,927
r
v
1
' Women Infants, and Children's Pro C
.f ' gram (R'I )
A VERA GE NUMBER OF VOUCHERS ISSUED PER MONTH
Fiscal Year 1995-96 Fiscal Year 1996-97
15,242 16,236
r
CONTRA COSTA ENVIRONMENTAL HEALTH
' ACTIVITY Fiscal Year 1995-96 Fiscal Year 1996-97
Incident Response' 13 14
Complaints' 27 33
rNotification 57 54
Haz Waste Generators4 52 52
rHaz Waste AB21854 50 49
Underground Tanks4 34 34
rSolid Wastes 749 608
Land Developments 908 909
' Consumer Protections 2,545 2,303
rMisc General Programs 22 62
Total Units 4;`l 18
c
_. , , .
rIndicates number of calls for an immediate response to a site
'Indicates number of responses to complaints which may or may not result in a visit to site.
' 3 Notifications by business that an event may result in a citizen inquiry.
4 Includes pre-,routine,and follow-up inspection,site remediation/soil samples
5 Includes routine,follow-up,complaint inspections or investigations,consultation,license or permit evaluation,
' direct abatement,and violation notices.
1
r
r
r
' vi
CONTRA COSTA EMERGENCY MEDICAL SERVICES '
ACTIVITIES Fiscal Year 1995-96 Fiscal Year 1996-97 '
Ambulance Services 46,969 46,890
Total Units Dispatched ,
Air Ambulance Services 280 268
Patient Transport
Trauma Services 1069 842
Critical trauma patients transported
First Responder Defibrillation Svs— 43 35 '
"Field Saves" (patient admitted)
First Responder Defibrillation Svs— 17 17 ,
" System Saves"(patient discharged)
Interfacility Transfer Reviews 831 907 ,
Cases Reviewed
y
Total Activities 49,209 48 959
CONTRA COSTA HAZARDOUS MATERIAL PROGRAM '
ACTIVITIES Fiscal Year 1995-96 Fiscal Year 1996-97 y
Notifications from Industry '
(of a hazardous materials incident) 701 671
Complaints Received and Addressed 367 420 ,
Number of Incidents Reported 205 213
47,:Total Activities 1,273 1,304
vii
TABLE 1 PERSONNEL
I
TABLE 1
' Staffing Patterns - FTE's*
YTD YTD %
Description May 1996 May 1997 Change
Staff by Division:
Detention 57.72 54.08 -6.3%
Public Health** 394.74 409.34 3.7%
IEnvironmental Health 73.37 73.32 -0.1%
CCS 43.81 48.81 11.4%
Substance Abuse 71.70 70.70 -1.4%
Mental Health 148.47 166.01 11.8%
Homeless 0.41 0.70
Finance 157.80 161.64 2.4%
Hospital 700.02 695.29 -0.7%
' Inpatient & Crisis Mental Health 115.99 114.60 -1.2%
Clinics-Ambulatory Care 255.20 278.59 9.2%
' Clinics-Older Adults 7.86 7.77 -1.1%
Medical Staff 177.45 178.98 0.90/0
Director's Office 17.92 18.29 2.1%
Emergency Medical Services 6.03 5.87 -2.7%
Enterprise Fund 1 sub-total 1,438.27 1,461.03 1.60/6
' Contra Costa Health Plan 61.66 65.19 5.7%
Grand Total 2,290.15. 2,349.17 2.6%
I
*Source: HSD Monthly FTE Reports
' **Includes Conservatorship
r
TABLE 2
PERSONNEL
Table 2 '
Affirmative Action Pattern - 1997
Total Positions 2620 ,
Funded
Total Positions 2155
Filled '
Total Positions 465
Vacant
EMPLOYEEBRE7D0 — —
Total 2155 100%
Male 501 23.2%
Female 1654 F- 76.7% 45.2% 45.2% 0
White 1287 60.1% 55.6% 55.6% 0
African American 327 15.1% 7.8% 7.8% 0 i
Hispanic 219 10.2% 10.6% 10.6% .5%
Asian/Filipino/ 0
Pacific Islander 301 13.9% 9.3% 9.3%
American Indian/ ,
Alaskan Native 21 1.0% 0.7% 0.7% 0
1
TABLE 3
1
1
HEALTH SERVICES DEPARTMENT
SICK LEAVE USAGE
FY 96/97 Value of
' Division Sick Leave Sick Leave Sick Leave
Hours Used Hours Earned Used (3)
r Hospital & Health Centers 94,802.10 93,372.47 $2,382,376.77
CCHP 3,086.20 3,274.57 73,760.18
Mental Health 9,860.20 11,065.44 247,195.21
Substance Abuse 5,702.60 4,611.31 102,133.57
Detention Facility 2,187.40 2,903.67 57,900.48
Public Health (1) 29,069.00 29,748.53 622,367.29
Homeless (2) 0.00 0.00 0.00
r Environmental Health 5.251.50 4,886.01 129.081.87
Total 149.959.00 149.862.00 $3.614.815.a7
' (1) Public Health includes Conservatorship and Calif. Children Services.
(2) Homeless did not have direct employee expense for FY96/97.
(3) Based on average hourly rate excluding benefits.
Source: County Payroll System Reports DA2663B and DA2663C
r0 1 23\payro1Kfy9697\s14j k.wk4
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